Clinical Radiology (2006) 61, 833e843

The radiology of IRIS (immune reconstitution

inflammatory syndrome) in patients with
mycobacterial tuberculosis and HIV
co-infection: appearances in 11 patients
G. Rajeswaran*, J.L. Becker, C. Michailidis, A.L. Pozniak, S.P.G. Padley

Department of Radiology and Department of HIV/GU Medicine,

Chelsea and Westminster Hospital, London, UK

Received 16 February 2006; received in revised form 16 April 2006; accepted 20 April 2006

AIM: To determine the radiological manifestations of IRIS (immune reconstitution inflammatory syndrome) in pa-
tients with HIV and mycobacterium tuberculosis co-infection, in the context of their demographic and clinical data.
MATERIALS AND METHODS: The radiological imaging, demographic and clinical data of 11 patients diagnosed with
IRIS associated with HIV and mycobacterial tuberculosis co-infection were studied retrospectively. Where available,
follow-up imaging studies were also reviewed.
RESULTS: The most common radiological feature of IRIS was lymph node enlargement (73%), with central low atten-
uation centres, in keeping with necrosis, present in most of these cases (88%). Most commonly affected were intra-
abdominal nodes (70%), followed by axillary (40%) and mediastinal lymph nodes (36%). Within the lung parenchyma,
diffuse, bilateral pulmonary nodules were seen in 55% of cases. Unilateral small volume pleural effusions were seen in
two cases with associated parenchymal changes seen in only one. Small volume ascites was seen in two cases. Thirty-
six percent of cases presented with new or worsening abscesses despite treatment. In this context, image-guided
radiological drainage proved a useful adjunct to the conventional medical therapy for IRIS. The most common clinical
signs of IRIS included fever (64%), abdominal pain (36%) and cough (27%).
CONCLUSION: We have described the radiological features that are characteristic in IRIS and the importance of put-
ting these into context with the clinical and pathological findings as part of a multidisciplinary approach in making the
diagnosis. The role of the radiologist is central in diagnosis, monitoring of disease progression and management of
complications in patients with IRIS.
ª 2006 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Introduction immunodeficiency virus (HIV) infection but appear

Immune reconstitution inflammatory syndrome
(IRIS) is defined as an exacerbation of the symp-
toms, signs, or radiological manifestations of a path-
ogenic antigen, which are not due to relapse or
recurrence. These paradoxical reactions have
been reported to occur in patients with both in-
fectious and non-infectious antigens. They have
also been well described in patients without human
* Guarantor and correspondent: G. Rajeswaran, Department
of Radiology and Department of HIV/GU Medicine, Chelsea
and Westminster Hospital, 369 Fulham Road, London SW10
9NH, UK. Tel.: þ44 2087468570; fax: þ44 2087468588.
E-mail address: grajeswaran@hotmail.com (G. Rajeswaran).
to occur more commonly in HIV-positive patients.1
Given the high prevalence of tuberculosis (TB) in pa-
tients with HIV, IRIS is seen most commonly in cases
of HIV and TB co-infection.2
The exact aetiology of IRIS is unknown, but in the
context of HIV and TB co-infection it is thought, in
part, to be secondary to highly active antiretroviral
therapy (HAART) related reconstitution of immunity,
leading to an abnormal immune response to antigens
released by dead or dying bacilli.1 IRIS can be dramatic
and result in considerable morbidity. Patients with HIV
and TB have diverse manifestations of IRIS. Pyrexia,
weight loss, respiratory failure, expanding brain
lesions, new or worsening lymph node enlargement,
hepatomegaly, splenomegaly, pulmonary infiltrates,

0009-9260/$ - see front matter ª 2006 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.crad.2006.04.007
 834
Table 1 Radiological and clinical features and subsequent management of IRIS in the 11 patients
Case Clinical features Imaging at time Radiological features of IRIS Management of IRIS
of IRIS of IRIS
Lymph node enlargement Lung Pleural Ascites Abscess Other
changes effusion
Chest Abdominal Other
01 Abdominal pain Chest N Y N N Y Y Y N Abscess drained
radiography, Coeliac, Right Small Psoas under CT guidance.
abdominal iliac volume Oral steroids.
radiography, CT Anti-TB restarted.
chest, abdomen, HAART continued.
pelvis
02 Increased size of Chest Y N N Y N N Y N Abscesses drained
axillary and radiography, Hilar, para- Fine Axillary, under US guidance.
sternal abscesses CT chest, tracheal nodules Sternal Oral steroids.
US abdomen HAART and anti-TB
continued.
03 Fever, abdominal Chest N Y N Y N Y Y Small Oral steroids.
pain, raised radiography, Retrocrural Miliary Small Liver, pericardial HAART and anti-TB
inflammatory CT chest, Nodules volume Spleen effusion continued.
markers abdomen, pelvis
04 Fever, vomiting, Chest Y Y Y Y N N N Y Anti-TB therapy and
cough, raised radiography, Pre-aortic, Porta, Axillary Miliary Mild hepato- oral steroids. HAART
inflammatory CT chest, pre- para-aortic, nodules megaly continued.
markers abdomen, tracheal, celiac,
pelvis, HRCT sub-carinal, splenic hilum
chest hilar
05 Fever, cough, Chest N N/i N Y N N/i N N Oral steroids. Anti-TB
infected PEG site, radiography, Miliary therapy resarted.
raised inflammatory HRCT chest nodules HAART continued.
markers

G. Rajeswaran et al.
06 Fever, vomiting, Chest Y N/i Y Y N N/i N N Oral steroids. HAART
cough, hoarseness, radiography, Para- Supra- Miliary and anti-TB
increased size of CT neck, tracheal, clavicular, nodules continued.
cervical lymph nodes chest pre-carinal axillary
07 Abdominal pain Chest N Y Y N N N Y N Oral steroids. HAART
radiography, Retro-crural, Axillary Liver, and anti-TB continued.
CT chest, para-aortic, spleen
abdomen, pelvis coeliac
 The radiology of IRIS in patients with mycobacterial tuberculosis and HIV co-infection
08 Abdominal pain Chest N Y N N N N Y N Oral steroids, IL2.
and tenderness radiography, Retro-crural, Psoas HAART and anti-TB
CT brain, para-aortic continued.
abdomen,
pelvis
09 Fever, weight Chest N N/i N/i Y Y N/i N Y Oral steroids. Anti-TB
loss, hemiparesis, radiography, Mililary Left Ring- and HAART continued.
facial weakness CT brain, nodules enhancing Recurrence of symptoms
MRI brain brain lesions with cessation of
treatment. Resolution
with continuation.
10 Fever, increased Chest N N N N N N Y N Drainage of abscess
size of sacral radiography, Gluteal under US guidance. Oral
abscess despite CT chest, steroids. HAART and
drainage abdomen, anti-TB continued.
pelvis
11 Fever Chest Y Y Y N N N N N Oral steroids. HAART
radiography, Pre- Coeliac, Axilla and anti-TB continued.
CT chest, tracheal, aorto-caval,
abdomen, sub-carinal, para-aortic,
pelvis, HRCT aorto- mesenteric
chest pulmonary
CT, computed tomography; US, ultrasound; MRI, magnetic resonance imaging; HRCT, high-resolution CT; TB, tuberculosis; HAART, highly active antiretroviral therapy; IL2, interleukin 2;
Ni, not imaged.

835
836 G. Rajeswaran et al.

serositis, and cutaneous lesions have all been de-
scribed in the clinical literature.2,3 However, the ra-
diological descriptions of TB and IRIS are limited.4e6
Manifestations usually resolve with continued treat-
ment against the offending pathogen as well as contin-
uation of HAART. Use of anti-inflammatory agents
such as corticosteroids can help modify the clinical
picture.3
Radiological imaging plays an important role in
IRIS. It is essential for both diagnosis and monitoring
of disease. Although there are limited papers de-
scribing the radiological manifestations of pulmo-
nary and extra-pulmonary TB in HIV, the imaging
findings during development and resolution of symp-
toms associated with IRIS in patients with HIV and TB
have not been extensively reported.4e8 Given the
relative paucity of reported radiological findings dur-
ing the clinical deterioration and recovery from IRIS
of patients with HIV and TB co-infection and given
its increasing prevalence, we present these findings
in the context of demographic and clinical data.
Materials and methods
Review of the TB/HIV unit database identified all
serologically proven HIV-positive patients receiving
HAART diagnosed with IRIS related to mycobacte-
rial tuberculosis infection between March 2001 and
July 2003 at our institution. The diagnosis of TB was
made definitively if cultures or genetic probes
were positive for Mycobacterium tuberculosis.

Figure 1 Contrast-enhanced CT images of patient 3, a 34-year-old heterosexual black African male with fully
sensitive TB at the time of HIV diagnosis. HAART and anti-TB therapy were commenced simultaneously and his symp-
toms improved. Four months later he presented with pyrexia, raised inflammatory markers and left sided abdominal
pain. CT image at TB presentation (a), demonstrating micro-abscesses within the spleen (white arrows). CT image at
IRIS presentation 2 months later, demonstrating increase in the number of micro-abscesses within the spleen (white
arrows) and micro-abscesses in the liver (black arrows) (b) and widespread miliary nodules in both lungs (c).
The radiology of IRIS in patients with mycobacterial tuberculosis and HIV co-infection 837

As a tertiary referral centre for HIV-related
disease, some patients in the database had initial
clinical management at other hospitals in the region
before being referred to our institution for further
care. All diagnoses of IRIS, as well as the imaging at
presentation of IRIS, occurred during the patients’
care at our institution.
IRIS was only diagnosed after all other causes
were reasonably excluded, including deterioration
due to treatment failure, the expected course of
a previously recognized infectious agent, drug
hypersensitivity or side effects, or newly acquired
infections. Imaging, blood, tissue and sputum
cultures, lymph node biopsy and other procedures
were performed as clinically indicated.
Case notes were reviewed for clinical data, CD4
count and viral loads at the time of commencement
of HAART and at presentation of IRIS. Radiology
reports and films were obtained together with
pathology and microbiology results for cultures,
smears and biopsies taken. Where imaging was
performed before IRIS presentation at other hospi-
tals, every effort was made to obtain the films as well
as the reports.
Fourteen patients were identified. Three pa-
tients had the diagnosis of IRIS made without

Figure 2 Axial CT images of patient 1, a 22-year-old heterosexual black African male treated for pulmonary and
abdominal TB also diagnosed at the time of HIV diagnosis. HAART was commenced after 2 months’ anti-TB therapy
with subsequent admission with abdominal pain, despite a favourable response to HAART. CT image at TB presentation
(a) demonstrating normal psoas muscles, peritoneal thickening (black arrows) and para-aortic lymph node enlarge-
ment (white arrows). Contrast-enhanced axial CT image at IRIS presentation demonstrating retrocrural lymph node
enlargement (white arrows) (b) and a right psoas abscess (white arrows) (c).
838 G. Rajeswaran et al.

requiring further radiological assessment. The
remaining 11 patients were studied retrospectively.
There were eight men and three women. The mean
age was 34.6 years. Of the eight male patients,
three were white, four were black African and one
was Asian. Three were heterosexual, four were
homosexual and one was a white homosexual in-
travenous drug abuser. All three females were black
African heterosexuals.
Of the 11 patients, six were referred to our
institution from different hospitals. Computed to-
mography (CT) examinations were performed using
a Siemens (Siemens AG, Wittelsbacherplatz 2, D-
80333. Munich. Germany) SOMATOM Sensation 16
Multislice Spiral machine. Examinations were per-
formed according to the clinical indication. CT of the
chest was performed using contrast-enhanced vol-
ume acquisition from the lung apices to the lung
bases with 1.5 mm section collimation. CT of the ab-
domen and pelvis was performed using volume acqui-
sition from the lung bases to the pubic symphysis
following oral and intravenous contrast medium
with 1.5 mm section collimation. Where further eval-
uation of the lung parenchyma was required, high-
resolution CT (HRCT) of the chest was performed
using interspaced acquisition from the lung apices
to the bases with 1 mm section collimation. CT of the
neck, where required, was performed as a contrast-
enhanced volume acquisition from the external
auditory meati to the sternal notch with 1.5 mm col-
limation. Two radiologists in consensus (S.P. and
G.R.) reviewed all of the radiological images.

Figure 3 Contrast-enhanced axial CT images of patient 8, who presented with symptomatic abdominal TB. HAART
was started 1 month after anti-TB therapy and resolution of symptoms. One month later he was admitted with abdom-
inal pain and tenderness and pyrexia. At TB presentation CT demonstrated no retrocrural nodes (a) and normal psoas
muscles (b). At the time of IRIS diagnosis, CT demonstrated retrocrural nodal enlargement with hypodense centres
suggesting necrosis (white arrows) (c) and a left psoas abscess (white arrows) (d).
The radiology of IRIS in patients with mycobacterial tuberculosis and HIV co-infection 839

Neither ethical board approval nor informed
patient consent was required for this study.
Results
Radiological findings
The radiological and clinical features and subse-
quent management of the 11 patients diagnosed
with IRIS are summarized in Table 1. At presentation
of IRIS, patients underwent radiological imaging at
our institution as clinically indicated. All patients
underwent chest radiography. Nine of these subse-
quently underwent CT of the chest, of which six un-
derwent a contrast-enhanced volume acquisition
only, one underwent an interspaced HRCT only,
and two required both imaging studies of the chest.
Eight patients underwent abdominal and pelvic im-
aging, with seven assessed by CT and one by ultra-
sound (US) only. One patient required magnetic
resonance imaging (MRI) and CT of the brain.
At presentation of IRIS, new or worsening lymph
node enlargement (in comparison with prior imag-
ing) was evident in eight of the 11 cases (73%) and
among these cases, signs of lymph node necrosis
with low attenuation centres were seen at CT in
seven (88%).
Within the chest, there was lymph node en-
largement in 36% (four of 11 patients) of cases, and
amongst these patients affected nodes involved
the hilar (n ¼ 2), para-tracheal (n ¼ 2), pre-tracheal
(n ¼ 2), sub-carinal (n ¼ 2), pre-carinal (n ¼ 1), and
aorto-pulmonary (n ¼ 1) regions. Parenchymal lung
changes seen at IRIS presentation were widespread
pulmonary nodules in 55% (six of the 11 patients) of
cases (Fig. 1c). This represented a worsening in
comparison with the previous imaging in 50% (three
of six patients) of these cases and was a new finding
in the other 50%. In all of these cases, the nodules
were not larger than 3 mm in size. Two patients
(18%) had small unilateral pleural effusions with
associated lung parenchymal changes seen in one.
A small pericardial effusion was seen in one case.
Within the abdomen and pelvis, there was lymph
node enlargement in 75% (six of eight patients) of
patients, and amongst these cases, affected nodes
involved the para-aortic (n ¼ 4), coeliax axis (n ¼ 4),
retro-crural (n ¼ 4) (Figs. 2b and 3b), porta hepatis
(n ¼ 2), mesenteric (n ¼ 1) and iliac (n ¼ 1) regions.
Micro-abscesses were seen in the liver and spleen in
two cases (Fig. 1b). Small volume ascites was seen
in 25% (two of eight patients). Lymph node enlarge-
ment was seen elsewhere in 40% of cases (four of
10 patients), involving the axillary (n ¼ 4) and supra-
clavicular (n ¼ 1) regions (Fig. 4a). None of the 11 pa-
tients underwent lymph node biopsy, which was not
felt to be appropriate for the diagnosis of IRIS in these
cases.
New or worsening abscesses despite treatment
occurred in four of 11 cases (36%). Two of these
cases presented with psoas abscesses (Figs. 2c and
3c), one with a gluteal abscess and one with axil-
lary and supraclavicular abscesses (Fig. 4b). One
patient presented with right hemiparesis and right
upper motor neurone facial weakness 7 months

Figure 4 Contrast-enhanced axial CT images of patient 6, diagnosed with HIV and fully sensitive abdominal and pul-
monary TB with enlargement of thoracic and cervical lymph nodes. HAART was started 2 months after anti-TB therapy
and he improved clinically. He represented 3 months later with increased pyrexia, cough, hoarseness, vomiting and
rapid nodal enlargement. CT image at TB presentation (a), demonstrating loss of the right supraclavicular fat plane
with lymph node enlargement (white arrow). CT image at IRIS presentation 5 months later, demonstrating worsening
of the right supra-clavicular lymph node enlargement with abscess formation (white arrows) (b).
840 G. Rajeswaran et al.

after HAART and anti-TB therapy, caused by TB

Time between starting

meningitis secondary to HAART. Ring-enhancing le-

Diagnosis (months)
sions were shown on MRI of the brain. In the seven

HAART and IRIS

patients who did not have abscesses at IRIS presen-
tation, resolution of signs and symptoms was

0.25e11
achieved with introduction of oral steroids, as

0.25
well as continuation of anti-TB therapy and HAART.

0.5

0.3

3.0
11
3
2

1
9

2
Of the four patients with abscesses, as well as the
treatment given to the other patients, one was
managed conservatively and three had successful

Time between starting

drainage of the abscesses performed with imaging

anti-TB therapy and

guidance.

HAART (months)
Two patients have been lost to further follow-up
(cases 3 and 4). Of the remaining nine patients,
seven have had no further relevant adverse epi-

0.25

0.75

0e7
sodes to date and follow-up imaging when per-

1.5
0
1
0

2
0

3
1

1
7

1
formed, has demonstrated differing degrees of
resolution of the previously noted radiological
signs with no new findings. Two patients have

of IRIS (copies/ml)
Viral load at time
had further adverse episodes. One of the patients

of presentation
with a left psoas abscess (case 8), which was

HAART, highly active anti-retroviral therapy; IRIS, immune reconstitution inflammatory syndrome; TB, tuberculosis.
managed conservatively, presented 4 months later

50e378
with a left groin swelling discharging pus. Repeat

128.3
201
134
378
54

50
190
204

50
50

50
50

54
CT of the abdomen and pelvis showed that the
psoas collection had resolved but a new collection
was now present in the left inguinal region. As this
range 500e1500 cells/ml

was spontaneously discharging, drainage was not

CD4 count at time of
presentation of IRIS

attempted and his medical therapy was supple-

(cells/ml), normal
Summary of the pathological findings of the 11 patients at TB and IRIS diagnosis

mented with a course of interleukin 2. The abscess

eventually drained to dryness and he has had no
further episodes. Another patient (case 11) pre-

16e266
sented 2 years after the initial IRIS presentation

127.0
266
170

16
78

196
97
64
89
219
170
32
97
with shortness of breath and pyrexia. A chest
radiograph revealed patchy air-space shadowing
bilaterally but predominantly at the right base in
Viral load at time

keeping with infective change. She deteriorated

TB (copies/ml)
of diagnosis of

50e1,200,000
rapidly and developed respiratory failure and 207,674.5

sepsis requiring intubation and intensive care

1,200,000
155,598
200,000

85,000
200
250,000
322,000
30,385
50
50
41,136
85,000

management. Despite this she died during the

same admission.

Pathological findings
normal range 500e1500 cells/ml

The median CD4 count at commencement of HAART

was 57 cells/ml (normal range 500e1500 cells/ml)
diagnosis of TB (cells/ml),

with a median viral load of 85,000 copies/ml. At

CD4 count at time of

presentation of IRIS the median CD4 count had

risen to 97 cells/ml and the median viral load had
fallen to 54 copies/ml. The median time from
commencement of HAART to diagnosis of IRIS was
2 months with a median time of 1 month between
2e122
55.5

commencement of HAART and TB treatment. These

86
57
18
5
55
80
19
79
87
122
2
57

results are summarized in Table 2 and represented

Table 2

graphically in Fig. 5. All patients had a positive

Median

Range
Mean
Case

genetic probe or culture for mycobacterium

01
02
03
04
05
06
07
08
09
10
11

tuberculosis at the time of diagnosis of TB/HIV.

The radiology of IRIS in patients with mycobacterial tuberculosis and HIV co-infection 841

Patient 1

Patient 2

Patient 3

Patient 4
Legend

X-axis = Time (months), range 0-12

Patient 5
Y-axis = CD4 Count (cells/µL), range 0-600, normal
values 500-1500 cells/µL
= CD4 count at TB diagnosis
Patient 6
= Time of starting HAART
= CD4 count at IRIS diagnosis

Patient 7 TB = Tuberculosis
HAART = Highly Active Antiretroviral
Therapy
IRIS = Immune Reconstitution
Patient 8 Inflammatory Syndrome

Patient 9

Patient 10

Patient 11

0 1 2 3 4 5 6 7 8 9 10 11 12

Figure 5 Timeline showing patients’ CD4 counts at TB and IRIS diagnosis in the context of starting HAART.

Clinical findings manifestations of TB, which are not due to relapse

The clinical features at IRIS presentation were fever
(64%), abdominal pain (36%), cough (27%), vomiting
(18%), increased size of abscesses (18%), increased
size of palpable lymph nodes (9%), hoarse voice (9%)
and neurological symptoms (9%).
Discussion
IRIS is a diagnosis of exclusion after ruling out
deterioration due to treatment failure, the
expected course of a previously recognized in-
fectious agent, drug hypersensitivity or side
effects or newly acquired infections.9 In the
context of HIV and TB co-infection, IRIS is defined
as an exacerbation of the clinical or radiological
or recurrence. This deterioration in clinical status
is attributable to recovery of the immune system,
or partial immune reconstitution during HAART.10
Patients affected with IRIS undergo deterioration
in their clinical status at a time when viral
replication appears to be under control and CD4
counts are rising, known as a paradoxical re-
sponse.10 The most common radiological features
of IRIS demonstrated in the present patient group
included new or worsening lymph node enlarge-
ment (in the abdomen, axilla and chest) and
diffuse, widespread pulmonary nodules. These
findings are in keeping with that of other smaller
series.
A previous study by Buckingham et al. docu-
menting five patients, reported two out of the five
patients presenting with symptoms of airway
842
compression secondary to mediastinal lymphade-
nopathy.5 Although the present study is not sig-
nificantly larger, encompassing only 11 patients,
no evidence was found to suggest that severe pre-
sentations of tuberculosis (airway narrowing, peri-
carditis, nerve paresis, superior vena caval
obstruction, fistula formation, etc.) are any more
common in patients with IRIS. Indeed the present
study is more in keeping with other previous stud-
ies, which also report that severe presentations of
TB are uncommon in IRIS.4,11,12
Unlike other series we found a significant
number of patients (36% or four of 11 cases)
presented with the relatively uncommon feature
of new or worsening abscesses despite treatment.
In this context, image-guided radiological drainage
proved a useful adjunct to the conventional med-
ical therapy for IRIS.
In our experience, the most common clinical
signs of IRIS were fever (64%), abdominal pain
(36%) and cough (27%). These non-specific symp-
toms are in keeping with previously reported
presentations of IRIS. Ten of the 11 patients had
a CD4þ T-lymphocyte count of less than 100 cells/ml
(normal range 500e1500 cells/ml) at commence-
ment of HAART. This supports the findings of previ-
ous studies and represents a conundrum in the
timing of initiation of HAART, balancing the risk
of development of IRIS against HIV disease progres-
sion.13e16 In the present series, the majority of
patients (82%) developed symptoms of IRIS within
3 months of starting HAART. This early onset after
commencement of HAART is in keeping with previ-
ous series.17,18 In two patients (cases 1 and 5),
there was a delayed time course before develop-
ment of symptoms of IRIS (11 and 9 months,
respectively). This delayed time course has been
described previously, and suggests that the diagno-
sis of IRIS cannot be excluded even 1 year after
starting HAART.5
Treatment regimes for patients presenting with
TB related IRIS include continuing primary therapy
against TB and continuation of HAART. Corticoste-
roids are used to improve symptoms. Treatment
with cytokines such as interleukin 2, can also be
effective as an adjunct and act to replace cytokines
depleted by an abnormal humoral immune re-
sponse. These usually only need to be administered
orally and intravenous steroids are only required if
oral drugs are poorly tolerated.
In the present cohort, CT of the clinically suspi-
cious area provided the definitive imaging study and
in our view is the imaging modality of choice.
We recognize a number of shortcomings of this
study. These include small patient numbers, the
retrospective design and limited follow-up data.
G. Rajeswaran et al.
However, to our knowledge, this study represents
the largest radiological review to date reflecting
the relative rarity of this entity.
For the radiologist, it is important to be aware of
IRIS as an entity and so recognize the common
radiological features that have been described in
this condition. However, as a diagnosis of exclusion,
it is essential that the radiological appearances are
put into context of the clinical and pathological
findings. As such, a multidisciplinary approach is
essential in making the correct diagnosis.
IRIS is now an increasingly recognized phenom-
enon and should be considered as a possibility in
the evaluation of all HIV patients on HAART who
unexpectedly deteriorate, particularly those with
TB. We have shown that there are common clinical
and radiological trends in patients presenting with
IRIS, and we would emphasize the central role of
the radiologist in diagnosis, monitoring of disease
progression and response to treatment, as well as
in providing radiologically guided management of
complications.
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