Clinical Profile of Patients with Immune Reconstitution Inflammatory Syndrome in Human Immunodeficiency Virus/Tuberculosis Coinfection and their Outcome: A Prospective Observational Study

TB associated with IRIS was 4%, and highly active ART (HAART)associated TB was 7.5%. 6ne of the critical risk factors for IRIS is an opportunistic infection at the time of starting ART.Another important risk factor IntroductIonHuman immunodeficiency virus (HIV)-associated TB is common, with an estimated 1.4 million cases and 374,000 deaths annually. 1RT is an essential, life-saving treatment for HIV.Still, HIV-infected patients initiating ART are at increased risk of TB-associated IRIS (TB-IRIS) in TB-endemic places.TB-IRIS is an acute inflammatory condition that causes worsening of TB in HIV patients on ATT after initiating ART (paradoxical TB-IRIS) or new onset of TB with the acute inflammatory response after starting ART (unmasking TB-IRIS). 2This is often attributed to the restoration of host immunity after ART initiation, which causes exaggerated inflammatory responses to Mycobacterium tuberculosis antigens. 3ymptoms of IRIS include fever and new or increased lymph node enlargement, often accompanied by reddening and inflammation of the overlying skin of enlarged lymph nodes, which can rupture to form sinuses.Other manifestations comprise pleural and pericardial effusion, psoas abscess, ascites, cutaneous lesions, new or increasing central nervous tuberculoma, and worsening of pulmonary lesions.Corticosteroid therapy is used to reduce the symptoms of IRIS. 4 A previous study from India reported that IRIS was seen in 7.6% of patients who started on ART. 5 In another prospective study, using consensus case definitions criteria, the incidence of paradoxical