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

  • Complications of Antiretroviral Therapy (JM Kilby, Section Editor)
  • Published:
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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.

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Acknowledgments

The work of IS and VS was supported by the Intramural Research Program of the National Institutes of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, MD, USA.

Compliance with Ethics Guidelines

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Conflict of Interest

Christina C. Chang, Virginia Sheikh, and Irini Sereti declare that they have no conflict of interest. Martyn French reports grants from National Health and Medical Research Council (Australia).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, 3000, Australia

    C. C. Chang

  2. Center for Biomedical Research, Burnet Institute, Melbourne, 3000, Australia

    C. C. Chang

  3. Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA

    V. Sheikh & I. Sereti

  4. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, 6009, Australia

    M. A. French

  5. Department of Clinical Immunology, Royal Perth Hospital and PathWest Laboratory Medicine, Perth, 6000, Australia

    M. A. French

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  1. C. C. Chang
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Chang, C.C., Sheikh, V., Sereti, I. et al. Immune Reconstitution Disorders in Patients With HIV Infection: From Pathogenesis to Prevention and Treatment. Curr HIV/AIDS Rep 11, 223–232 (2014). https://doi.org/10.1007/s11904-014-0213-0

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