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Paradoxical Reactions of Tuberculosis in Patients With the Acquired Immunodeficiency Syndrome Who Are Treated With Highly Active Antiretroviral Therapy

Enrique Navas, MD; Pilar Martín-Dávila, MD; Leonor Moreno, MD; Vicente Pintado, MD; José L. Casado, MD; Jesús Fortún, MD; María J. Pérez-Elías, MD; Enrique Gomez-Mampaso, MD; Santiago Moreno, MD
Arch Intern Med. 2002;162(1):97-99. doi:.
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The administration of highly active antiretroviral therapy (HAART) has produced a significant decrease in acquired immunodeficiency syndrome–related opportunistic infections, but also has changed the natural history and the usual presentation of some of these infections.14 Soon after the introduction of combination regimens that included protease inhibitors, several researchers reported unusual clinical features in patients who developed opportunistic diseases after the initiation of HAART. The new clinical features have been well described for disseminated Mycobacterium avium complex disease5 and for cytomegalovirus retinitis,6 and were given the generic name of "reactivation syndrome" or "immune reconstitution syndrome." This syndrome was attributed to the immunologic recovery produced by HAART, which could enhance the inflammatory response around the infection, producing either a relapse of clinical symptoms or the appearance of new-onset opportunistic infections.7

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