ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2013
Frequency, severity, and prediction of tuberculous meningitis immune reconstitution inflammatory syndrome.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03092817 (A Randomized Double Blind Placebo Controlled Trial of Adjunctive Dexamethasone for the Treatment of HIV-infected Adults With Tuberculous Meningitis), which is not on this map. Cited by 93 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized Double Blind Placebo Controlled Trial of Adjunctive Dexamethasone for the Treatment of HIV-infected Adults With Tuberculous Meningitis
Who cites it
93 citing papers in PubMed, 4 syntheses or guidelines pooled it, 181 citations in OpenAlex.
- A clinical practice guideline for tuberculous meningitis.The Lancet. Infectious diseases · 2026Guideline
- Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis.Journal of neurology · 2022Pooled it
- Pooled it
- Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Updated Guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014Guideline
- Incidence and Predictors of Tuberculosis-associated IRIS in People With HIV Treated for Tuberculosis: Findings From Reflate TB2 Randomized Trial.Open forum infectious diseases · 2024Trial
- Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults.The New England journal of medicine · 2023Trial
- Mycobacterial antigen driven activation of CD14++CD16- monocytes is a predictor of tuberculosis-associated immune reconstitution inflammatory syndrome.PLoS pathogens · 2014Trial
- Inflammation Precedes Paradoxical Reactions in HIV-Negative Patients With Pulmonary Tuberculosis.Open forum infectious diseases · 2026Article
- Inflammatory biomarkers as predictors of paradoxical reaction in tubercular meningitis: a prospective observational study.BMJ neurology open · 2026Article
- Miliary Tuberculosis: A Comprehensive Review of Epidemiology, Clinical Manifestations, Diagnosis, Treatment, and Complications.Infection and drug resistance · 2026Review
- Thalidomide as an Adjunctive Therapy for HIV-Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series.Open forum infectious diseases · 2025Article
- Single-cell profiling of blood and cerebrospinal fluid in tuberculous meningitis.Journal of immunology (Baltimore, Md. : 1950) · 2025Article
- A Study of the Association of Cerebrospinal Fluid Neutrophil-to-Lymphocyte Ratio with Severity and Mortality in Patients with Tuberculous Meningitis.Annals of Indian Academy of Neurology · 2025Article
- MMPs and NETs are detrimental in CNS-tuberculosis with MMP Inhibition in CNS-tuberculosis mice improving survival.Journal of neuroinflammation · 2025Article
- Tuberculosis Related Movement Disorders: A Systematic Scoping Review Highlighting Geographic Disparities, Phenotypic Patterns, Treatment Responses, and Knowledge Gaps in Global Reporting.Movement disorders clinical practice · 2025Article
- Standardized Infliximab Regimen to Treat Severe Central Nervous System Tuberculosis: A Case Series of 18 Patients.Open forum infectious diseases · 2025Article
- Tuberculosis disease among people with HIV: therapeutic advances.The lancet. HIV · 2025Review
- Tuberculous compound palmar ganglion: unravelling a rare diagnosis.International journal of burns and trauma · 2025Article
- Paradoxical Reactions of Central Nervous System Tuberculosis: Report of Three Immunocompetent Cases.Case reports in infectious diseases · 2025Article
- Tuberculous ventriculitis as a devastating neurological manifestation of immune reconstitution inflammatory syndrome: A case report in immunocompetent patient.International journal of surgery case reports · 2024Article
33 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundTuberculosis immune reconstitution inflammatory syndrome (IRIS) is a common cause of deterioration in human immunodeficiency virus (HIV)-infected patients receiving tuberculosis treatment after starting antiretroviral therapy (ART). Potentially life-threatening neurological involvement occurs frequently and has been suggested as a reason to defer ART.
methodsWe conducted a prospective study of HIV-infected, ART-naive patients with tuberculous meningitis (TBM). At presentation, patients started tuberculosis treatment and prednisone; ART was initiated 2 weeks later. Clinical and laboratory findings were compared between patients who developed TBM-IRIS (TBM-IRIS patients) and those who did not (non-TBM-IRIS patients). A logistic regression model was developed to predict TBM-IRIS.
resultsForty-seven percent (16/34) of TBM patients developed TBM-IRIS, which manifested with severe features of inflammation. At TBM diagnosis, TBM-IRIS patients had higher cerebrospinal fluid (CSF) neutrophil counts compared with non-TBM-IRIS patients (median, 50 vs 3 cells ×10(6)/L, P = .02). Mycobacterium tuberculosis was cultured from CSF of 15 TBM-IRIS patients (94%) compared with 6 non-TBM-IRIS patients (33%) at time of TBM diagnosis; relative risk of developing TBM-IRIS if CSF was Mycobacterium tuberculosis culture positive = 9.3 (95% confidence interval [CI], 1.4-62.2). The combination of high CSF tumor necrosis factor (TNF)-α and low interferon (IFN)-γ at TBM diagnosis predicted TBM-IRIS (area under the curve = 0.91 [95% CI, .53-.99]).
conclusionsTBM-IRIS is a frequent, severe complication of ART in HIV-associated TBM and is characterized by high CSF neutrophil counts and Mycobacterium tuberculosis culture positivity at TBM presentation. The combination of CSF IFN-γ and TNF-α concentrations may predict TBM-IRIS and thereby be a means to individualize patients to early or deferred ART.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.