Prednisone Reduces the Risk for TB-Associated IRIS

Administering prednisone during the first 4 weeks of antiretroviral therapy in patients with HIV/tuberculosis coinfection lowers the incidence of TB-associated immune reconstitution inflammatory syndrome without an increase in complications.

Throughout the world, tuberculosis (TB) remains the most common opportunistic infection at HIV diagnosis; many patients with this coinfection present with low CD4 counts. Starting antiretroviral therapy (ART) within 2 weeks of starting TB treatment decreases the risk for mortality in patients with CD4 count <50 cells/µL (NEJM JW HIV/AIDS Dec 2011 and N Engl J Med 2011; 365:1492) but increases the risk for immune reconstitution inflammatory syndrome (IRIS; NEJM JW HIV/AIDS Dec 2012 and Ann Intern Med 2012; 157:313). Investigators from South Africa studied if administering a short course of prednisone (40 mg per day for 14 days followed by 20 mg per day for 14 days) would decrease the risk for TB-associated IRIS.

A total of 240 HIV-infected pa…

Reviewing Author

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

Prednisone Reduces the Risk for TB-Associated IRIS

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Reviewing Author