Persistent High Mortality in Advanced HIV/TB Despite Appropriate Antiretroviral and Antitubercular Therapy: an Emerging Challenge

Gregory P. Bisson, Nicola Zetola, Ronald G. Collman

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations

Abstract

Approximately 1.1 million, or 13 %, of all TB cases in 2013 were coinfected with HIV, and in some African countries, such as Botswana and Swaziland, 60–80 % of TB cases are coinfected with HIV. Effective therapies for both HIV and TB exist, yet patients presenting with TB and advanced HIV still experience high rates of morbidity and mortality despite initiation of both antitubercular and antiretroviral therapy (ART). Previous reviews and research have focused largely on TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) as a type of complicated outcome on ART in advanced HIV/TB, but recent data indicate that immunologic failure despite suppressive ART is associated with early mortality. In this review, we examine recent findings regarding early mortality in HIV/TB and emerging concepts in the pathophysiology of TB-IRIS, in order to provide an integrated view of factors determining outcomes in coinfected people as well as highlight key needs for future research and therapeutic development.

Original languageEnglish (US)
Pages (from-to)107-116
Number of pages10
JournalCurrent HIV/AIDS Reports
Volume12
Issue number1
DOIs
StatePublished - Mar 22 2015
Externally publishedYes

Keywords

  • HIV
  • Immune reconstitution inflammatory syndrome
  • Immunology
  • Mortality
  • Tuberculosis

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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