Thalidomide as an adjunctive therapy for HIV-TB associated immune reconstitution inflammatory syndrome: A case series

Structured Abstract Background A small proportion of patients with tuberculous related immune reconstitution inflammatory syndrome (TB-IRIS) in people living with human Immunodeficiency virus (PWH) have prolonged and complicated courses and demonstrate either poor response to corticosteroid therapy, relapse after withdrawing, or intolerability demonstrating a need for alternative immunomodulatory options. Thalidomide has been shown to have immunomodulatory effects, primarily in neurological TB in children, however there is little description of its use in adult patients. Method We describe the clinical course of 7 patients with complicated HIV-associated TB-IRIS treated with thalidomide. Results The clinical manifestations included CNS (n=4) TB, tuberculous adenitis (n=2) and recurrent tuberculous psoas collection (n=1). All were given thalidomide 100mg for between 6 and 12 months with favourable clinical outcomes and no adverse effects. Conclusion Thalidomide remains an agent with clinical utility in this small subset of patients and further research to determine optimal dosing and duration could be beneficial.