Wednesday, January 2, 2008

Immune Reconstitution Inflammatory Syndrome (IRIS)

Opportunistic diseases previously attributed to a deficient immune system are occurring in those whose surrogate markers are improving due to HAART. The explanation given is that a newly robust immune system can lead to hyper inflammatory responses. We will overlook the fact that such was precisely the problem while the immune system was depressed and instead look at the paper entitled Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options, which describes the syndrome in detail.

Some patients initiating ART experience unique symptoms during immune system recovery. In these patients, clinical deterioration occurs despite increased CD4+ T-lymphocyte counts and decreased plasma HIV-1 viral loads [4]. This clinical deterioration is a result of an inflammatory response or "dysregulation" of the immune system to both intact subclinical pathogens and residual antigens [5-9]. Resulting clinical manifestations of this syndrome are diverse and depend on the infectious or noninfectious agent involved. These manifestations include mycobacterial-induced lymphadenitis [5], paradoxical tuberculosis reactions [6,7,10,11], worsening of progressive multifocal leukoencephalopathy (PML) [12], recurrence of cryptococcosis and Pneumocystis jirovecii pneumonia (PCP) [8,13-16], Cytomegalovirus (CMV) retinitis [17], shingles [18], and viral hepatitis [19], as well as noninfectious phenomena [20].

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