Risk for TB-Associated IRIS in Persons with HIV on INSTI-Based Therapy

Immune reconstitution inflammatory syndrome (IRIS) develops in some persons with HIV (PWH) after they start antiretroviral therapy (ART) and is more common in those with low CD4 counts and high levels of viremia. In a secondary analysis of the REFLATE TB2 trial, investigators evaluated whether PWH with tuberculosis (TB) who started integrase strand transfer inhibitor (INSTI)-based therapy had elevated risk for developing IRIS. In all, 453 PWH with TB from low/middle income countries who were naive to ART were randomized to receive tenofovir/lamivudine with either raltegravir or efavirenz. Median baseline CD4 count was 102 cells/mm³ and median HIV-1 RNA was 5.5 log₁₀ copies/mL. ART was started a median 20 days after initiation of TB therapy.…