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Background  CD4 +  T cell activation indicators have been reported to be a common phenomenon underlying diverse manifestations of immune reconstitution inflammatory syndrome (IRIS). However, we have found that a high frequency of circulating CD8 +  T cells is a specific risk factor for mycobacterial IRIS. Therefore, we investigated whether CD8 +  T cells from patients who develop TB IRIS were specifically activated.    Methods  We obtained PBMCs from HIV+ patients prior to and 4, 8, 12, 24, 52 and 104 weeks after initiating antiretroviral therapy. CD38 and HLADR expression on naive, central memory and effector memory CD8 +  and CD4 +  T cells were determined by flow cytometry. Absolute counts and frequencies of CD8 +  T cell subsets were compared between patients who developed TB IRIS, who developed other IRIS forms and who remained IRIS-free.    Results  TB IRIS patients showed significantly higher counts of naive CD8 +  T cells than the other groups at most time points, with a contraction of the effector memory subpopulation occurring later in the follow-up period. Activated (CD38 +  HLADR + ) CD8 +  T cells from all groups decreased with treatment but transiently peaked in TB IRIS patients. This increase was due to an increase in activated naive CD8 +  T cell counts during IRIS. Additionally, the CD8 +  T cell subpopulations of TB IRIS patients expressed HLADR without CD38 more frequently and expressed CD38 without HLADR less frequently than cells from other groups.    Conclusions  CD8 +  T cell activation is specifically relevant to TB IRIS. Different IRIS forms may involve different alterations in T cell subsets, suggesting different underlying inflammatory processes.

journal of inflammation

Transient expansion of activated CD8+ T cells characterizes tuberculosis-associated immune reconstitution inflammatory syndrome in patients with HIV: a case control study