TNF and Mycobacterial Infection: A Double-Edged Sword?

Tumor necrosis factor (TNF) inhibitors increase the risk for mycobacterial disease, suggesting that TNF protects against these infections. However, TNF also promotes inflammation, and high levels are found in HIV-infected patients with mycobacterial immune reconstitution inflammatory syndrome (IRIS). The possibility that this cytokine could be playing a role led investigators to assess the potential benefit of infliximab — a TNF inhibitor — in patients with mycobacterial IRIS.

Three HIV-infected patients presented with mycobacterial IRIS after initiation of antiretroviral therapy: Two had Mycobacterium tuberculosis IRIS; one had Mycobacterium avium complex IRIS. In all cases, the IRIS event involved worsening lymphadenopathy. Other findings …