Clinics in chest medicine
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Clinics in chest medicine · Dec 2009
ReviewTuberculosis-associated immune reconstitution inflammatory syndrome and unmasking of tuberculosis by antiretroviral therapy.
The tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a frequent early complication of antiretroviral therapy (ART), used to treat HIV-1 infection, especially in countries where TB is prevalent. TB-IRIS is characterized by an exaggerated inflammatory response toward the antigens of Mycobacterium tuberculosis that results in clinical deterioration in patients experiencing immune recovery during early ART. ⋯ Paradoxical TB-IRIS manifests with new or recurrent TB symptoms or signs in patients being treated for TB during early ART, and unmasking TB-IRIS is characterized by an exaggerated, unusually inflammatory initial presentation of TB during early ART. In this review the incidence, clinical features, risk factors, treatment, and prevention of TB-IRIS in adult and pediatric patients are discussed.
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Tuberculosis (TB) ranks second only to human immunodeficiency virus as a cause of death from an infectious agent (1.77 million deaths from TB in 2007). Global targets for reductions in the epidemiologic burden of TB have been set for 2015 and 2050 within the context of the Millennium Development Goals and the Stop TB Partnership. Achieving these targets is the focus of national and international efforts in TB control, and demonstrating whether or not they are achieved is of major importance. This article discusses: the methods used by the World Health Organization to estimate the global burden of TB; estimates of incidence, prevalence, and mortality for 2007, combined with assessment of progress toward the 2015 targets for reductions in these indicators based on trends since 1990 and projections up to 2015; trends in TB notifications and case detection rates; and prospects for elimination of TB by 2050.