Incidence and impact of immune reconstitution inflammatory response syndrome associated with tuberculosis regarding the initiation of antiretroviral treatment during antituberculosis therapy in adult patients co-infected with tuberculosis and HIV: A systematic review

Abstract

Antiretroviral therapy (ART) is a fundamental key in the fight against HIV, it allows the patient to have a prolonged and high quality life, however in coinfection with opportunistic diseases such as tuberculosis, the initiation of ART can generate a greater risk of immune reconstitution inflammatory syndrome when associated with antituberculosis treatment, generating an exacerbated inflammatory response in tissues rich in Mycobacterium tuberculosis, characterized by the clinical worsening of the patient. The picture ranges from mild and self-limited symptoms to more severe effects and even death.Objectives: This systematic review aims to describe and evaluate the impact, incidence, severity and morbidity of immune reconstitution syndrome (IRRS) on the condition of HIV-positive patients, taking into account the time of ART initiation during antituberculosis treatment. Material and methods: Randomized clinical studies, case-control studies, prospective and retrospective cohorts of the last 11 years, without language limits, obtained from search bases such as PubMed, Cochrane, Embase, performed in adult humans co-infected with mycobacterium tuberculosis and human immunodeficiency virus ( HIV) were evaluated. Results: TO total of 22 scientific articles were selected and analyzed, 8 of which report that early, immediate and integrated ART of HIV in patients co-infected with TB improved survival despite the higher incidence of TB-SIRI, on the other hand 5 clinical studies affirm that integrated ART generated severe clinical pictures of SIRI-TB and increased mortality, however 5 studies observed that it is more beneficial to initiate ART at any time of anti-tuberculosis treatment, than not to initiate it. Conclusion:our analysis considers it necessary to implement antiretroviral treatment (ART) early in patients coinfected with HIV and TB regardless of the CD4 + cell / mm count, despite the risk of developing another complication such as LRTI associated with TB, taking into account the adequate management of prevention with the corresponding treatment of the opportunistic infection that precedes it, as well as the early diagnosis of LRTI-TB and its consequent treatment, which is not addressed in this review