ArticleInternational journal of STD & AIDS2020
Anakinra in the treatment of protracted paradoxical inflammatory reactions in HIV-associated tuberculosis in the United Kingdom: a report of two cases.
Article in International journal of STD & AIDS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- A clinical practice guideline for tuberculous meningitis.The Lancet. Infectious diseases · 2026Guideline
- Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults.The New England journal of medicine · 2023Trial
- Temporal shifts in adaptive immunity drive HIV-associated cryptococcal IRIS: mechanisms, models, and therapeutic opportunities.NeuroImmune pharmacology and therapeutics · 2026Article
- Prolonged Paradoxical TB-IRIS: 2 Case Reports and a Review of the Literature.Open forum infectious diseases · 2026Article
- Context-specific roles for IL-17 in tuberculosis.PLoS pathogens · 2026Review
- Clinical characteristics of childhood tuberculous meningitis and risk factors for severe neurological sequelae disaggregated by age group.BMC infectious diseases · 2026Article
- A 24-Year-Old Man with Disseminated Tuberculosis and A Corticosteroid-Refractory Paradoxical Reaction to Anti-Tuberculous Treatment.European journal of case reports in internal medicine · 2026Article
- Successful management of severe IRIS associated with disseminated histoplasmosis in an HIV patient using cytokine adsorption therapy and JAK inhibition.AIDS research and therapy · 2025Article
- Tuberculosis disease among people with HIV: therapeutic advances.The lancet. HIV · 2025Review
- Tuberculosis: An Update for the Clinician.Respirology (Carlton, Vic.) · 2025Review
- Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature.BMC infectious diseases · 2024Review
- Post-tuberculosis treatment paradoxical reactions.Infection · 2024Review
- Article
- A teenage girl with altered mental status and paraparesis.Journal of clinical tuberculosis and other mycobacterial diseases · 2024Article
- Advancing Diagnosis and Treatment in People Living with HIV and Tuberculosis Meningitis.Current HIV/AIDS reports · 2023Review
- Review
- Concurrence of cat-scratch disease and paradoxical tuberculosis-IRIS lymphadenopathy: a case report.BMC infectious diseases · 2022Article
- Systemic Inflammation Associated with Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV.Life (Basel, Switzerland) · 2021Review
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Paradoxical reactions, including immune reconstitution inflammatory syndrome (IRIS), are common in patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB). Paradoxical reactions may confer substantial morbidity and mortality, especially in cases of central nervous system (CNS) TB, or through protracted usage of corticosteroids. No high-quality evidence is available to guide management in this scenario. Interleukin-1-mediated inflammation has been implicated in the pathophysiology of TB-IRIS. We describe two cases where anakinra (human recombinant interleukin-1 receptor antagonist) was used as steroid-sparing therapy for life-threatening protracted paradoxical inflammation in HIV-associated TB. In the first case of disseminated TB with lymphadenitis, protracted TB-IRIS led to amyloid A amyloidosis and nephrotic syndrome. In the second case of disseminated TB with cerebral tuberculomata, paradoxical inflammation caused unstable tuberculomata leading to profound neuro-disability. In both cases, paradoxical inflammation persisted for over a year. Protracted high-dose corticosteroid use led to adverse events yet failed to control inflammatory pathology. In both patients, anakinra successfully controlled paradoxical inflammation and facilitated withdrawal of corticosteroid therapy. Following anakinra therapy, nephrotic syndrome and neuro-disability resolved, respectively. Anakinra therapy for protracted paradoxical inflammation in HIV-associated TB may be a viable therapeutic option and warrants further research.
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