Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings

G. Meintjes, S.D. Lawn, F. Scano, G. Maartens, Martyn French, W. Worodria, J.H. Elliott, D. Murdoch, R.J. Wilkinson, C. Seyler, L. John, M.S. Van Der Loeff, P. Reiss, L. Lynen, E.N. Janoff, C. Gilks, R. Colebunders

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    The immune reconstitution inflammatory syndrome (IRIS) has emerged as an important early complication of antiretroviral therapy (ART) in resource-limited settings, especially in patients with tuberculosis. However, there are no consensus case definitions for IRIS or tuberculosis-associated IRIS. Moreover, previously proposed case definitions are not readily applicable in settings where laboratory resources are limited. As a result, existing studies on tuberculosis-associated IRIS have used a variety of non-standardised general case definitions. To rectify this problem, around 100 researchers, including microbiologists, immunologists, clinicians, epidemiologists, clinical trialists, and public-health specialists from 16 countries met in Kampala, Uganda, in November, 2006. At this meeting, consensus case definitions for paradoxical tuberculosis-associated IRIS, ART-associated tuberculosis, and unmasking tuberculosis-associated IRIS were derived, which can be used in high-income and resource-limited settings. It is envisaged that these definitions could be used by clinicians and researchers in a variety of settings to promote standardisation and comparability of data.
    Original languageEnglish
    Pages (from-to)516-523
    JournalThe Lancet Infectious Diseases
    Issue number8
    Publication statusPublished - 2008


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