Current HIV/AIDS Reports

, Volume 9, Issue 3, pp 238–250

Management of the Immune Reconstitution Inflammatory Syndrome

Co-infections (C Benson, Section Editor)

Abstract

The immune reconstitution inflammatory syndrome (IRIS) is a frequent early complication of antiretroviral therapy (ART) in patients with advanced HIV. Because there is no confirmatory diagnostic test, the diagnosis is based on clinical presentation and exclusion of alternative causes for deterioration, such as antimicrobial drug resistance. Opportunistic infection treatment should be optimized. Mild cases may require symptomatic therapy alone or nonsteroidal anti-inflammatory drugs. Corticosteroids have been used to treat more severe cases of IRIS associated with mycobacterial and fungal infections. There is evidence from a randomized controlled trial that prednisone reduces morbidity and improves symptoms in paradoxical tuberculosis (TB)-IRIS. Neurological TB-IRIS is potentially life-threatening; high-dose corticosteroids are indicated and ART interruption should be considered if level of consciousness is depressed. When considering corticosteroid treatment clinicians should be aware of their side effects and only use them when the diagnosis of IRIS is certain. In viral forms of IRIS corticosteroids are generally avoided.

Keywords

HIV AIDS Antiretroviral therapy Immune reconstitution inflammatory syndrome Tuberculosis Cryptococcosis Mycobacterial disease Cytomegalovirus Kaposi’s sarcoma Progressive multifocal leukoencephalopathy Viral hepatitis Corticosteroids 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Graeme Meintjes
    • 1
    • 2
    • 3
    • 4
    • 7
  • James Scriven
    • 1
    • 5
    • 7
  • Suzaan Marais
    • 1
    • 6
    • 7
  1. 1.Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
  2. 2.Division of Infectious Diseases and HIV MedicineUniversity of Cape TownCape TownSouth Africa
  3. 3.GF Jooste HospitalCape TownSouth Africa
  4. 4.Department of MedicineImperial College LondonLondonUK
  5. 5.Liverpool School of Tropical MedicineLiverpool UniversityLiverpoolUK
  6. 6.Division of Neurology, Department of MedicineUniversity of Cape TownCape TownSouth Africa
  7. 7.Institute of Infectious Diseases and Molecular Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa

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