Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients
Journal
Current Opinion in Infectious Diseases
Journal Volume
22
Journal Issue
4
Pages
394-402
Date Issued
2009
Author(s)
Singh N.
Abstract
PURPOSE OF REVIEW: In the era of highly active antiretroviral therapy, immune reconstitution inflammatory syndrome has become well recognized in the HIV-infected population. However, little is known about its occurrence in non-HIV immunocompromised hosts. The present review aims to propose the pathogenesis of immune reconstitution inflammatory syndrome, summarize its occurrence in immunocompromised patients without HIV infection, and suggest potential treatment options. RECENT FINDINGS: Immune reconstitution inflammatory syndrome is exuberant and dysregulated inflammatory responses to invading microorganisms. It manifests when an abrupt shift of host immunity from an anti-inflammatory and immunosuppressive status towards a pathogenic proinflammatory state occurs as a result of rapid decreases or removal of factors promoting immunosuppression or inhibiting inflammation. In addition to HIV-infected patients, immune reconstitution inflammatory syndrome has also been observed in solid organ transplant recipients, women during the postpartum period, neutropenic patients, and tumor necrosis factor antagonist recipients. Corticosteroids are the most commonly employed treatment, whereas other potential agents based on its pathogenesis deserve further investigation. SUMMARY: Non-HIV immunocompromised hosts develop immune reconstitution inflammatory syndrome when the sudden change in the dominant T helper responses to inflammation is not well balanced by anti-inflammatory responses. Judicious manipulation of host immunity and timely recognition of immune reconstitution inflammatory syndrome as we deal with the infections in these populations is critical to limit or avoid the harm by immune reconstitution inflammatory syndrome. ? 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
SDGs
Other Subjects
corticosteroid derivative; hydroxymethylglutaryl coenzyme A reductase inhibitor; immunoglobulin; infliximab; nonsteroid antiinflammatory agent; anal tuberculosis; drug withdrawal; graft recipient; human; immune reconstitution inflammatory syndrome; immunocompromised patient; immunosuppressive treatment; invasive candidiasis; lung tuberculosis; miliary tuberculosis; neutropenia; organ transplantation; pathogenesis; puerperium; review; tuberculosis; tuberculous pleurisy; vitrectomy; Adrenal Cortex Hormones; Humans; Immune Reconstitution Inflammatory Syndrome; Immunocompromised Host; Immunosuppression; Immunosuppressive Agents; Neutropenia; Organ Transplantation; Postpartum Period
Type
review