Prednisone for the Prevention of Paradoxical Tuberculosis-Associated IRIS

Department For International Development

October 21
14:06 2019


Early initiation of antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected patients who have tuberculosis reduces mortality among patients with low CD4 counts, but it increases the risk of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS).

The authors conducted this randomized, double-blind, placebo-controlled trial to assess whether prophylactic prednisone can safely reduce the incidence of paradoxical tuberculosis-associated IRIS in patients at high risk for the syndrome. They enrolled HIV-infected patients who were initiating ART (and had not previously received ART), had started tuberculosis treatment within 30 days before initiating ART, and had a CD4 count of 100 cells or fewer per microliter. Patients received either prednisone (at a dose of 40 mg per day for 14 days, then 20 mg per day for 14 days) or placebo. The primary end point was the development of tuberculosis-associated IRIS within 12 weeks after initiating ART, as adjudicated by an independent committee.

This research was supported by the UK Department for International Developments Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)


Harries AD, Takarinda KC. F1000Prime Recommendation of [Meintjes G et al., N Engl J Med 2018 379(20):1915-1925]. F1000Prime. 2019. Available from:

Prednisone for the Prevention of Paradoxical Tuberculosis-Associated IRIS

Published 14 January 2019