Diagnosis and Management of Paradoxical TB-IRIS

Tuberculosis (TB) is a common opportunistic infection in HIV patients, particularly in TB-endemic countries like Indonesia, increasing mortality rates. HIV patients require early anti-retroviral (ARV) treatment, but coexisting TB can lead to immune reconstitution inflammatory syndrome (IRIS), worsening clinical outcomes and increasing mortality. TB-IRIS is categorized into paradoxical TB-IRIS, occurring in patients previously treated for TB, and unmasking TB-IRIS, occurring in newly diagnosed TB patients after ARV initiation. Clinical manifestations include worsening respiratory symptoms and new lesions in other organs. Diagnosis requires excluding other conditions like opportunistic infections or TB treatment failure. Prevention strategies include TB screening before ARV initiation, appropriate timing of ARV administration, and using corticosteroids like prednisone to reduce exacerbation risk. Management focuses on supportive therapy, inflammation control, and continuation of ARV and TB treatment. Early detection, prevention, and proper management can significantly reduce TB-IRIS morbidity and mortality.