Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs or radiographic manifestations of TB after beginning anti-TB treatment. This paradoxical reaction in HIV-infected patients with TB is thought to be a result of immune reconstitution.This occurs as a result of the simultaneous administration of ART and anti-TB drugs. Symptoms and signs may include high fever, lymphadenopathy, expanding central nervous system lesions and worsening of CXR findings. A thorough evaluation is necessary to exclude other causes, particularly TB treatment failure, before diagnosing a paradoxical reaction. For severe paradoxical reactions, prednisone (1-2 mg/kg for 1-2 weeks, then gradually decreasing doses) may help, although there is no evidence for this.
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