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Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patients Receiving Antiretroviral Therapy

Pathogenesis, Clinical Manifestations and Management

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Abstract

The use of antiretroviral therapy (ART) to treat HIV infection, by restoring CD4+ cell count and immune function, is associated with significant reductions in morbidity and mortality. Soon after ART initiation, there is a rapid phase of restoration of pathogen-specific immunity. In certain patients, this results in inflammatory responses that may result in clinical deterioration known as ‘the immune reconstitution inflammatory syndrome’ (IRIS). IRIS may be targeted at viable infective antigens, dead or dying infective antigens, host antigens, tumour antigens and other antigens, giving rise to a heterogeneous range of clinical manifestations. The commonest forms of IRIS are associated with mycobacterial infections, fungi and herpes viruses. In most patients, ART should be continued and treatment for the associated condition optimized, and there is anecdotal evidence for the use of corticosteroids in patients who are severely affected. In this review, we discuss research relating to pathogenesis, the range of clinical manifestations, treatment options and prevention issues.

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Notes

  1. Purified protein derivative of tuberculin skin test.

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Acknowledgements

Dr Dheda is supported by a SA NRF and DST Research Chair award. Dr Meintjes is supported by a Wellcome Trust Fellowship. The authors have no conflicts of interest that are directly relevant to the contents of this review.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Harefield Hospital, Middlesex, UK

    Devesh J. Dhasmana

  2. Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa

    Keertan Dheda

  3. Centre for Infectious Diseases and International Health, University College London, London, UK

    Keertan Dheda

  4. Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark

    Pernille Ravn

  5. Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa

    Robert J. Wilkinson &  Graeme Meintjes

  6. GF Jooste Hospital, Cape Town, South Africa

    Robert J. Wilkinson &  Graeme Meintjes

  7. Wellcome Trust Centre for Research in Clinical Tropical Medicine, Division of Medicine, Wright Fleming Institute, Imperial College London, London, UK

    Robert J. Wilkinson

  8. Department of Medicine, University of Cape Town, Faculty of Health Sciences, Anzio Road, Observatory 7925, Cape Town, South Africa

    Robert J. Wilkinson &  Graeme Meintjes

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  1. Devesh J. Dhasmana
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Correspondence to Graeme Meintjes.

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Dhasmana, D.J., Dheda, K., Ravn, P. et al. Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patients Receiving Antiretroviral Therapy. Drugs 68, 191–208 (2008). https://doi.org/10.2165/00003495-200868020-00004

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