Current HIV/AIDS Reports

, Volume 11, Issue 3, pp 223–232

Immune Reconstitution Disorders in Patients With HIV Infection: From Pathogenesis to Prevention and Treatment

Complications of Antiretroviral Therapy (JM Kilby, Section Editor)

Abstract

An immune reconstitution disorder occurs in up to 40 % of severely immunodeficient HIV patients who commence antiretroviral therapy (ART), with an immune reconstitution inflammatory syndrome (IRIS) being encountered most commonly. Differences in the immunopathogenesis of an IRIS associated with different types of pathogen have become apparent but common features have also been defined. These include severe immunodeficiency prior to commencing ART associated with a high pathogen load and ‘compensatory’ immune responses, particularly innate immune responses, which inadequately control the pathogen and increase the risk of immunopathology as the immune system recovers on ART. Prevention of an IRIS may be achieved by optimising therapy for opportunistic infections before ART is commenced, delaying ART or using immunomodulatory therapy to prevent or suppress the immune response that causes the immunopathology. However, further clinical studies are required to examine these options in a systematic manner for the various types of IRIS.

Keywords

HIV Immune reconstitution disorders Immune reconstitution inflammatory syndrome (IRIS) 

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • C. C. Chang
    • 1
    • 2
  • V. Sheikh
    • 3
  • I. Sereti
    • 3
  • M. A. French
    • 4
    • 5
  1. 1.Department of Infectious DiseasesAlfred Hospital and Monash UniversityMelbourneAustralia
  2. 2.Center for Biomedical ResearchBurnet InstituteMelbourneAustralia
  3. 3.Laboratory of Immunoregulation, National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaUSA
  4. 4.School of Pathology and Laboratory MedicineUniversity of Western AustraliaPerthAustralia
  5. 5.Department of Clinical ImmunologyRoyal Perth Hospital and PathWest Laboratory MedicinePerthAustralia

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