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1. Introduction
2. Disease in Cape town
3. A triple coincidence that leads to HIV-TB-IRIS
4. Antiretroviral therapy improves immunity
5. Pathological immunity may be restored by ART
6. A wide range of IRIS conditions
7. Two forms of IRIS associated with tuberculosis
8. Paradoxical TB-IRIS
9. Clinical manifestations of paradoxical TB-IRIS
10. Histopathology of IRIS
11. How significant is IRIS?
12. Diagnosing IRIS
13. Challenges in diagnosing IRIS
14. Pathogenesis of TB-IRIS
15. IFN-gamma secreting T cells and TB-IRIS (1)
16. HIV-TB-IRIS and M. tuberculosis specific T cells
17. T cell expansion & contraction in IRIS & non-IRIS
18. T cell expansion further investigation
19. IFN-gamma secreting T cells and TB-IRIS (2)
20. What is the role of cytokines?
21. Cytokine and MMP analysis
22. Myeloid origin pro-inflammatory cytokines
23. Supernatant cytokines of myeloid origin
24. Myeloid origin serum pro-inflammatory cytokines
25. Multiply elevated cytokines accompany TB-IRIS
26. Management of TB-IRIS
27. Randomized trial of prednisone vs. placebo
28. Primary endpoint
29. Secondary endpoints
30. C-reactive protein
31. Immunological analysis
32. Th1 contraction & expansion: corticosteroids
33. Interleukin-6
34. Interleukin-10
35. Interleukin-12p40
36. Tumor necrosis factor
37. Interferon-gamma
38. Interferon gamma inducible protein 10 (CXCL10)
39. Further evidence of innate immune involvement
40. Suppurative necrosis may accompany TB-IRIS
41. A potential role for neutrophils
42. Uncharacteristic cavitation in HIV-TB
43. MMP genes and endogenous inhibitors
44. In vitro secretion of matrix metalloproteinases
45. Serum level of matrix metalloproteinases
46. Conclusions: MMP in TB-IRIS
47. Conclusions: TB-IRIS
48. Acknowledgements

Topics Covered

• TB-immune reconstitution inflammatory syndrome (IRIS) is a common complication of combined antitubercular and antiretroviral therapy
• The two forms of IRIS: paradoxical and unmasking
• Lack of a diagnostic test for TB-IRIS
• Expansion of Interferon gamma secreting T cells is associated with TB-IRIS
• Multiple cytokines are elevated in TB-IRIS, many of myeloid origin
• Benefits of adjunctive corticosteroid therapy in TB-IRIS
• Steroid therapy reduces the levels of IL-6, IL-10, IL-12p40, TNF, Interferon-gamma and CXCL-10 in TB-IRIS patients
• Suppurative necrosis may occur in TB-IRIS, implying a role for neutrophils
• Evidence of a prominent role for myeloid cells in the pathogenesis of TB-IRIS

Links

Series:

• Cells of the Innate Immune System

Categories:

• Biochemistry
• Cell Biology
• Clinical Practice
• Immunology
• Microbiology

Therapeutic Areas:

• Immunology & Inflammation
• Infectious Diseases

Talk Citation

Wilkinson, R. and Meintjes, G. (2012, April 3). The role of myeloid cells in HIV associated immune reconstitution inflammatory syndrome [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved June 10, 2023, from https://hstalks.com/bs/2279/.
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Publication History

• Published on April 3, 2012

Financial Disclosures

• Prof. Robert Wilkinson has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
• Prof. Graeme Meintjes has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.