Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome-An Extempore Game of Misfiring with Defense Arsenals

The lethal combination involving TB and HIV, known as syndemic diseases, synergistically act upon one another to magnify the disease burden. Individuals on anti-retroviral therapy (ART) are at risk of developing TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). The underlying inflammatory complication includes the rapid restoration of immune responses following ART, eventually leading to exaggerated inflammatory responses to MTB antigens. TB-IRIS continues to be a cause of morbidity and mortality among HIV/TB coinfected patients initiating ART, and although a significant quantum of knowledge has been acquired on the pathogenesis of IRIS, the underlying pathomechanisms and identification of a sensitive and specific diagnostic marker still remain a grey area of investigation. Here, we reviewed the latest research developments into IRIS immunopathogenesis, and outlined the modalities to prevent and manage strategies for better clinical and diagnostic outcomes for IRIS.

Automated summary

The combination of tuberculosis (TB) and human immunodeficiency virus (HIV) known as syndemic diseases, have a synergistic effect on each other, resulting in a greater disease burden. Individuals undergoing anti-retroviral therapy (ART) are at risk of developing TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). Although significant progress has been made in understanding the pathogenesis of IRIS, the underlying mechanisms and identification of sensitive and specific diagnostic markers remain areas of investigation. This review covers the latest research on IRIS immunopathogenesis, as well as preventive and management strategies for better clinical and diagnostic outcomes.