The immune reconstitution inflammatory syndrome related to HIV co-infections: A review
Journal
European Journal of Clinical Microbiology and Infectious Diseases
Journal Volume
31
Journal Issue
6
Pages
919-927
Date Issued
2012
Author(s)
Abstract
The immune reconstitution inflammatory syndrome (IRIS) is a consequence of an excessive pathogenspecific immune recovery reaction and occurs in a subset of patients on antiretroviral therapy (ART). Infective forms of IRIS may present either as an 'unmasking' of a previously subclinical infection or the paradoxical clinical deterioration of an infection for which the patient received appropriate antimicrobial therapy. The most important risk factors for IRIS are a low CD4+ T-cell count and a short time between treatment of the infection and the commencement of ART. The general approach to the treatment of IRIS is to continue ART and provide antimicrobial therapy for the provoking infection. The majority of cases are selflimiting; however, mortality and hospitalisation rates are particularly high when tuberculosis- or cryptococcal-IRIS affects the central nervous system (CNS). Corticosteroid therapy should be considered in certain forms of IRIS after the exclusion of other conditions that could explain the inflammatory manifestations in the patients. Given that a low CD4+ T-cell count is a major risk factor for the development of IRIS, commencing ART at a CD4+ T-cell count of >350/μL will prevent most cases. ? Springer-Verlag 2011.
SDGs
Other Subjects
antiretrovirus agent; corticosteroid; nonsteroid antiinflammatory agent; prednisone; thalidomide; anti human immunodeficiency virus agent; antiinfective agent; antiinflammatory agent; atypical mycobacteriosis; atypical Mycobacterium; CD4 lymphocyte count; clinical feature; cryptococcosis; Cytomegalovirus; Cytomegalovirus retinitis; disease activity; disease association; drug dose reduction; drug efficacy; drug safety; drug tolerability; genital herpes; hepatitis B; hepatitis C; human; Human immunodeficiency virus infection; immune reconstitution inflammatory syndrome; infection risk; Kaposi sarcoma; leishmaniasis; meningoencephalitis; mixed infection; molecular pathology; molluscum contagiosum; nonhuman; priority journal; progressive multifocal leukoencephalopathy; review; risk assessment; risk factor; schistosomiasis; Strongyloides stercoralis; syndrome delineation; toxoplasmosis; tuberculosis; verruca vulgaris; Human immunodeficiency virus infection; immune reconstitution inflammatory syndrome; immunology; mixed infection; pathology; Anti-HIV Agents; Anti-Infective Agents; Anti-Inflammatory Agents; CD4 Lymphocyte Count; Coinfection; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome
Type
review