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Progressive symptoms and signs following institution of highly active antiretroviral therapy and subsequent antituberculosis therapy: immune reconstitution syndrome or infection?
  1. R F Miller1,
  2. M Shahmanesh2,
  3. M D Talbot3,
  4. M J Wiselka4,
  5. P J Shaw5,
  6. C Bacon6,
  7. C M Robertson7
  1. 1Centre for Sexual Health and HIV Research, Department of Population Sciences and Primary Care, Royal Free and University College Medical School, University College London, London WC1E 6AU, UK
  2. 2Department of Genitourinary Medicine, Whittall Street Clinic, Birmingham B4 6DH, UK
  3. 3Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
  4. 4Department of Infection and Tropical Medicine, Leicester Royal Infirmary, Leicester LE1 5WW, UK
  5. 5Department of Imaging, University College London Hospitals, London NW1 2BU, UK
  6. 6Department of Histopathology, Royal Free and University College Medical School, University College London, London WC1E 6AU, UK
  7. 7Department of Genitourinary Medicine, Coventry and Warwickshire Hospital, Coventry CV1 4FH, UK
  1. Correspondence to:
 Dr R F Miller
 Centre for Sexual Health and HIV Research, Royal Free and University College Medical School, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK; rmiller{at}


A 36 year old man presented with weight loss, cough, fever, and exertional dyspnoea shortly after a diagnosis of HIV infection. Symptoms and initial radiological abnormalities worsened after highly active antiretroviral therapy was started. An eventual diagnosis was established but multiple problems occurred throughout the treatment period. Differentiation between immune reconstitution inflammatory syndrome and an infective cause was problematic.

  • AAFB, alcohol and acid fast bacilli
  • BAL, bronchoscopic alveolar lavage
  • BM, bone marrow
  • CRP, C reactive protein
  • HAART, highly active antiretroviral therapy
  • Hb, haemoglobin
  • IRIS, immune reconstitution inflammatory syndrome
  • LDH, lactate dehydrogenase
  • MDR-TB, multidrug resistant tuberculosis
  • PCP, Pneumocystis jirovecii pneumonia
  • WBC, white blood cell
  • HIV
  • AIDS
  • tuberculosis
  • immune reconstitution inflammatory syndrome

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  • Conflict of interest: Dr R F Miller is co-editor of, and Dr M Shahmanesh is journal ombudsman for, Sexually Transmitted Infections, part of the BMJ Publishing Group.

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