TY - JOUR
T1 - Unmasked tuberculosis and tuberculosis immune reconstitution inflammatory disease
T2 - A disease spectrum after initiation of antiretroviral therapy
AU - Manabe, Yukari C.
AU - Breen, Ronan
AU - Perti, Tara
AU - Girardi, Enrico
AU - Sterling, Timothy R.
N1 - Funding Information:
Received 23 May 2008; accepted 11 August 2008; electronically published 17 December 2008. Potential conflicts of interest: none reported. Financial support: National Institutes of Health (grant HL71554 to Y.C.M. and grant K24 AI065298 to T.R.S.). Reprints or correspondence: Dr. Yukari C. Manabe, Infectious Diseases Institute, Johns Hopkins University School of Medicine, 2190 Kampala Pl., Dulles, VA 20189-2190 (ymanabe@jhmi.edu).
PY - 2009/2/1
Y1 - 2009/2/1
N2 - Antiretroviral therapy (ART) has beneficial effects on mortality and lowers the incidence of diseases caused by opportunistic infections, such as tuberculosis (TB). Although ART has sustained long-term benefits, the risk of TB is high during the first 3 months after ART initiation. Among cases of ART-associated TB, we define "unmasked TB" as that which occurs in patients with reactivation disease who develop clinically recognizable TB after ART with the restoration of previously acquired TB antigen-specific functional immune responses. TB cases with clinical evidence of an inflammatory syndrome are a subset of these unmasked cases, which we define as "unmasked TB-immune reconstitution inflammatory syndrome." With more widespread use of ART in areas with a high prevalence of TB, unmasked TB will likely become more common. TB diagnostics with improved sensitivity and specificity are urgently needed to detect subclinical TB before it is unmasked.
AB - Antiretroviral therapy (ART) has beneficial effects on mortality and lowers the incidence of diseases caused by opportunistic infections, such as tuberculosis (TB). Although ART has sustained long-term benefits, the risk of TB is high during the first 3 months after ART initiation. Among cases of ART-associated TB, we define "unmasked TB" as that which occurs in patients with reactivation disease who develop clinically recognizable TB after ART with the restoration of previously acquired TB antigen-specific functional immune responses. TB cases with clinical evidence of an inflammatory syndrome are a subset of these unmasked cases, which we define as "unmasked TB-immune reconstitution inflammatory syndrome." With more widespread use of ART in areas with a high prevalence of TB, unmasked TB will likely become more common. TB diagnostics with improved sensitivity and specificity are urgently needed to detect subclinical TB before it is unmasked.
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U2 - 10.1086/595985
DO - 10.1086/595985
M3 - Article
C2 - 19090776
AN - SCOPUS:58849123233
SN - 0022-1899
VL - 199
SP - 437
EP - 444
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 3
ER -