Quinn Carson M, Poplin Victoria, Kasibante John, Yuquimpo Kyle, Gakuru Jane, Cresswell Fiona V, Bahr Nathan C
School of Medicine, University of California, San Francisco, CA 94143, USA.
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Life (Basel). 2020 Oct 29;10(11):262. doi: 10.3390/life10110262.
Antiretroviral therapy (ART), while essential in combatting tuberculosis (TB) and HIV coinfection, is often complicated by the TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). Depending on the TB disease site and treatment status at ART initiation, this immune-mediated worsening of TB pathology can take the form of paradoxical TB-IRIS, unmasking TB-IRIS, or CNS TB-IRIS. Each form of TB-IRIS has unique implications for diagnosis and treatment. Recently published studies have emphasized the importance of neutrophils and T cell subtypes in TB-IRIS pathogenesis, alongside the recognized role of CD4 T cells and macrophages. Research has also refined our prognostic understanding, revealing how the disease can impact lung function. While corticosteroids remain the only trial-supported therapy for prevention and management of TB-IRIS, increasing interest has been given to biologic therapies directly targeting the immune pathology. TB-IRIS, especially its unmasking form, remains incompletely described and more data is needed to validate biomarkers for diagnosis. Management strategies remain suboptimal, especially in the highly morbid central nervous system (CNS) form of the disease, and further trials are necessary to refine treatment. In this review we will summarize the current understanding of the immunopathogenesis, the presentation of TB-IRIS and the evidence for management recommendations.
抗逆转录病毒疗法（ART）在对抗结核病（TB）和艾滋病毒合并感染方面至关重要，但常因结核病相关免疫重建炎症综合征（TB-IRIS）而变得复杂。根据ART启动时的结核病发病部位和治疗状况，这种由免疫介导的结核病病理恶化可表现为矛盾性TB-IRIS、暴露性TB-IRIS或中枢神经系统TB-IRIS。每种形式的TB-IRIS在诊断和治疗方面都有独特的意义。最近发表的研究强调了中性粒细胞和T细胞亚型在TB-IRIS发病机制中的重要性，以及CD4 T细胞和巨噬细胞的公认作用。研究还完善了我们对预后的理解，揭示了该疾病如何影响肺功能。虽然皮质类固醇仍然是唯一经试验支持用于预防和管理TB-IRIS 的疗法，但人们对直接针对免疫病理的生物疗法的兴趣日益增加。TB-IRIS，尤其是其暴露性形式，仍未得到充分描述，需要更多数据来验证诊断生物标志物。管理策略仍然不够理想，尤其是在该疾病高发病率的中枢神经系统（CNS）形式中，需要进一步试验来优化治疗。在本综述中，我们将总结目前对免疫发病机制、TB-IRIS表现以及管理建议证据的理解。
