Prevalence, risk factors, clinical characteristics and outcomes of tuberculosis-associated immune reconstitution inflammatory syndrome in a HIV and tuberculosis low-incidence setting

BACKGROUND: Most data on tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in people living with HIV (PWH) come from high TB/HIV-incidence settings. We described TB-IRIS in a low-incidence setting and applied International Network for the Study of HIV-associated IRIS (INSHI) case definitions. METHODS: Single-center retrospective study in Italy including PWH with TB (2013-2023). RESULTS: Among 21 PWH, 2 developed unmasking and 3 paradoxical TB-IRIS, diagnosed with radiology, histology, clinical parameters and inflammatory markers. Disseminated TB and shorter TB-treatment-to-ART intervals were more common in IRIS. One paradoxical case would have been missed by INSHI criteria. CONCLUSION: TB-IRIS was common; inflammatory markers could aid diagnosis.