Work

Reply to Reyes‐Corcho and Bouza‐Jiménez

Year: 2010

Type: letter

Abstract: To the Editor—I appreciate the comments of Drs Reyes-Corcho and Bouza-Jiménez [1]. I agree that there are 2 types of tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS)—unmasked cases, in which tuberculosis is diagnosed after the initiation of antiretroviral therapy (ART), and paradoxical cases, which occur in patients already receiving antituberculosis treatment before the initiation of ART. I disagree that all cases of tuberculosis that occur soon after the initiation of ART should be called unmasked TB-IRIS. There is a spectrum of post-ART tuberculosis. Only a proportion of the patients in this spectrum present with the exuberant inflammatory syndrome that is TB-IRIS. I do not think that all cases of tuberculosis that become clinically recognizable during the first 3 months after the initiation of ART should be classified as unmasked TB-IRIS; rather, I concur with Lawn et al [2] that the broader term post-ART tuberculosis should be used. As stated in the article by my colleagues and I, we agree that post-ART tuberculosis is certainly a challenge for tuberculosis control and that subclinical cases that occur before the initiation of ART may contribute to high early mortality [3]. Better tests that can identify subclinical or disseminated disease in patients are urgently needed.

Source: The Journal of Infectious Diseases

DOI: 10.1086/649821

Author: Yukari C. Manabe

Institutions: Johns Hopkins University, Infectious Diseases Institute, Makerere University

Language: English

Topic: Tuberculosis Research and Epidemiology

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funders: Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health