Thalidomide as an Adjunctive Therapy for HIV-Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series.

Background: A small proportion of people living with human immunodeficiency virus (HIV) who have tuberculosis-related immune reconstitution inflammatory syndrome (tuberculosis-IRIS) have prolonged and complicated courses and experience poor response to corticosteroid therapy, relapse after withdrawing, or intolerability demonstrating a need for alternative immunomodulatory options. Thalidomide has been shown to have immunomodulatory effects, primarily in neurological tuberculosis in children, but there is little description of its use in adult patients. Methods: We describe the clinical course in 7 adult patients with complicated HIV-associated tuberculosis-IRIS treated with thalidomide. Results: The clinical manifestations included central nervous system tuberculosis (n = 4) , tuberculous adenitis (n = 2), and recurrent tuberculous psoas collection (n = 1). All patients were given thalidomide (100 mg) for 6-12 months, with favorable clinical outcomes and no adverse effects. Conclusions: Thalidomide dosed at 100 mg/d remains an agent with clinical utility in this small subset of patients, and further research to determine optimal dosing and duration could be beneficial.