Tuberculosis-associated immune reconstitution inflammatory syndrome: a manifestation of adaptive or innate immunity?

In The Lancet Infectious Diseases, Shruthi Ravimohan and colleagues¹ investigate whether immunological profiles before and after antiretroviral therapy (ART) can distinguish patients co-infected with HIV and tuberculosis who develop tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS) from those who do not develop this disorder and those who have early mortality. The investigators noted decreased pre-ART concentrations of several pro-inflammatory cytokines in patients with tuberculosis-associated IRIS (eg, interleukin [IL]-6 adjusted odds ratio [OR] per 1 log₁₀ increase 0·40 [95% CI 0·18–0·89]), which resurged during the disease. After ART initiation, the most prominent changes in patients with tuberculosis-associated IRIS were reported for cytokines related to innate immunity (eg, IL-6: adjusted OR 1·7 [95% CI 1·2–2·5] and tumour necrosis factor [TNFα: 1·5 [1·0–2·2]), whereas recovery of the CD4 T-cell compartment was similar to that shown in control participants who survived without a diagnosis of tuberculosis-associated IRIS.