Tuberculosis-Associated Immune Reconstruction Inflammatory Syndrome (TB-IRIS) in HIV-Infected Patients: Report of Two Cases and the Literature Overview

Table 1

Case definition for “paradoxical” tuberculosis-associated immune reconstruction inflammatory syndrome (TB-IRIS) for use in resource-limited settings [7].

Three components to this case definition:
(1) Antecedent requirements (both of the following requirements must be met):
(1) Diagnosis of TB	Made before starting of combination antiretroviral therapy (CART) and should fulfill WHO criteria
(2) Initial response to TB treatment	The patient’s condition should have stabilized or improved on appropriate TB treatment before CART initiation
(2) Clinical criteria
The onset of TB-associated IRIS manifestations should be within 3 months of CART initiation, reinitiation, or regimen change because of; treatment failure
Of the following, at least one major criterion or two minor clinical criteria are required:
Major criteria
	New or enlarging lymph nodes, cold abscesses, or other tissue involvement
	New or worsening radiological features of TB
	New or worsening central nervous system CNS TB
	New or worsening serositis
Minor criteria
	New or worsening constitutional symptoms such as fever, night sweats, or weight loss
	New or worsening respiratory symptoms as cough, dyspnea, or stridor
	New or worsening abdominal pain accompanied by peritonitis, hepatomegaly, splenomegaly, or abdominal adenopathy
(3) Excluded alternative explanations for clinical deterioration
	Failure of TB treatment because of TB drug resistance
	Poor adherence to TB treatment
	Another opportunistic infection or neoplasm
	Drug toxicity or reaction