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J Infect Dis. 2009 Feb 1;199(3):437-44. doi: 10.1086/595985.

Unmasked tuberculosis and tuberculosis immune reconstitution inflammatory disease: a disease spectrum after initiation of antiretroviral therapy.

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  • 1Center for Tuberculosis Research, Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA. ymanabe@jhmi.edu

Abstract

Antiretroviral therapy (ART) has beneficial effects on mortality and lowers the incidence of diseases caused by opportunistic infections, such as tuberculosis (TB). Although ART has sustained long-term benefits, the risk of TB is high during the first 3 months after ART initiation. Among cases of ART-associated TB, we define "unmasked TB" as that which occurs in patients with reactivation disease who develop clinically recognizable TB after ART with the restoration of previously acquired TB antigen-specific functional immune responses. TB cases with clinical evidence of an inflammatory syndrome are a subset of these unmasked cases, which we define as "unmasked TB-immune reconstitution inflammatory syndrome." With more widespread use of ART in areas with a high prevalence of TB, unmasked TB will likely become more common. TB diagnostics with improved sensitivity and specificity are urgently needed to detect subclinical TB before it is unmasked.

PMID:
19090776
[PubMed - indexed for MEDLINE]
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