The immunopathogenesis of the HIV tuberculosis immune reconstitution inflammatory syndrome

Eur J Immunol. 2013 Aug;43(8):1995-2002. doi: 10.1002/eji.201343632.


HIV-1 patients co-infected with some pathogens are at risk of developing the immune reconstitution inflammatory syndrome (IRIS) when initiating antiretroviral therapy (ART). IRIS is characterized by inflammation leading to the clinical worsening of a treated infection or the unmasking of a previously undiagnosed condition or infection. It is commonly associated with tuberculosis (TB), 8-43% of the HIV-TB co-infected patients prescribed with antitubercular treatment and ART develop TB-IRIS. Although IRIS has been recognized for over 20 years, relatively little was known until recently about its pathogenesis. Despite these advances in understanding IRIS, there remains no immune biomarker for diagnostic or prognostic purposes. Here, we review the risk factors associated with TB-IRIS, the challenges in studying this syndrome, and how T lymphocytes, dysregulated cytokine responses, and innate immunity may contribute to the development of TB-IRIS.

Keywords: Drug therapy complications; HIV-1 infection; Immune reconstitution inflammatory syndrome; Tuberculosis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Retroviral Agents / adverse effects*
  • Anti-Retroviral Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Biomarkers
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology
  • Coinfection
  • Cytokines / metabolism
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / immunology*
  • HIV-1
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / diagnosis
  • Immune Reconstitution Inflammatory Syndrome / immunology*
  • Risk Factors
  • T-Lymphocyte Subsets / immunology
  • Tuberculosis / complications
  • Tuberculosis / drug therapy
  • Tuberculosis / immunology*


  • Anti-Retroviral Agents
  • Antitubercular Agents
  • Biomarkers
  • Cytokines