Paradoxical aggravation of tuberculosis after antiretroviral treatment in HIV-infected patients

BACKGROUND: Restoration of immunocompetence in HIV-infected patients after antiretroviral treatment can have unexpected effects. CASE REPORTS: An unusual course of treated tuberculosis was observed in fou r HIV-infected patients soon after initiation of antiretroviral therapy. Th ese patients developed fever and enlarged necrotic adenopathies despite an efficacious antituberculous therapy. They were in the initial stage of thei r antituberculous therapy that had been initiated a mean 12 days prior to i nitiation of antiretroviral therapy. The antiretroviral therapy led to an u ndetectable HIV load within 2 months. DISCUSSION: These unusual features, which also occurred with an increase in CD4 cell counts, could be related to the immunological restoration and to the reappearance of delayed type hypersensitivity. The onset of antiretrovi ral therapy could thus be delayed by several weeks in HIV-infected patients treated for active tuberculosis and who have never received antiretroviral therapy.