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Persistent High Mortality in Advanced HIV/TB Despite Appropriate Antiretroviral and Antitubercular Therapy: an Emerging Challenge

  • HIV Pathogenesis and Treatment (AL Landay, Section Editor)
  • Published:
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Abstract

Approximately 1.1 million, or 13 %, of all TB cases in 2013 were coinfected with HIV, and in some African countries, such as Botswana and Swaziland, 60–80 % of TB cases are coinfected with HIV. Effective therapies for both HIV and TB exist, yet patients presenting with TB and advanced HIV still experience high rates of morbidity and mortality despite initiation of both antitubercular and antiretroviral therapy (ART). Previous reviews and research have focused largely on TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) as a type of complicated outcome on ART in advanced HIV/TB, but recent data indicate that immunologic failure despite suppressive ART is associated with early mortality. In this review, we examine recent findings regarding early mortality in HIV/TB and emerging concepts in the pathophysiology of TB-IRIS, in order to provide an integrated view of factors determining outcomes in coinfected people as well as highlight key needs for future research and therapeutic development.

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Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Gregory Bisson declares a grant from NIAID, is a consultant to Pfizer and Celgene, and has provided expert testimony for Levaquin Litigation Fund, LLC.

Nicola Zetola declares that he has no conflict of interest.

Ronald Collman declares multiple grants from NIH.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Gregory P. Bisson & Nicola Zetola

  2. Division of Pulmonary and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Ronald G. Collman

  3. Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Gregory P. Bisson

  4. Botswana-UPenn Partnership, Gaborone, Botswana

    Gregory P. Bisson & Nicola Zetola

  5. Perelman School of Medicine at the University of Pennsylvania, 832 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA

    Gregory P. Bisson

  6. Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Gregory P. Bisson

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Bisson, G.P., Zetola, N. & Collman, R.G. Persistent High Mortality in Advanced HIV/TB Despite Appropriate Antiretroviral and Antitubercular Therapy: an Emerging Challenge. Curr HIV/AIDS Rep 12, 107–116 (2015). https://doi.org/10.1007/s11904-015-0256-x

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