Figure 4.

Linked tuberculosis (TB)–specific T-cell and innate immune responses as measured by systemic interleukin 6 (IL-6) characterized TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). A, Non-IRIS controls with change in TB-specific polyfunctional (interferon gamma [IFN-γ⁺]/interleukin 2 [IL-2⁺]/tumor necrosis factor alpha [TNF-α⁺]) CD4⁺ T-cell responses post–antiretroviral therapy (ART) initiation that were above the median for the group were identified from Figure 2. Control patients with above-median TB-specific IFN-γ responses measured previously by enzyme-linked immunospot (ELISpot) assay [15] (B), as well as higher than median increase in CD4 count on ART (C), were identified. Change in circulating IL-6 levels from baseline to week 4 post-ART were compared between controls with high adaptive cellular immune response to all TB-IRIS patients with corresponding data. Bars indicate median change in IL-6 concentration with interquartile range, which was previously quantitated by Luminex assay [15]. Wilcoxon rank-sum tests were used to determine P values.