Immune Reconstitution Inflammatory Syndrome

摘要: The prognosis of patients with human immunodeficiency virus (HIV) infection has dramatically improved since the advent potent antiretroviral therapy (ART), which enabled sustained suppression HIV replication, recovery CD4 Tcell counts, and a substantial decrease in frequency opportunistic infections (OIs) mortality. In three large retrospective studies, up to 30% ART responders developed one or more inflammatory syndromes consistent immune reconstitution syndrome (IRIS). One study reported 182 episodes IRIS: most frequently associated were localized varicella-zoster (22%), TB (20%), nontuberculous mycobacterial (NTM) (17%), cytomegalovirus (CMV; 12%), cryptococcal (6%). conducted on over 300 HIVinfected commencing country high prevalence TB, whole-blood IFN- γ release assay was used demonstrate that T-cell IFN-γ responses PPD increased who paradoxical ‘’unmasking’’ TB-IRIS. Narita et al. documented reactions common HIV-infected after starting compared not HIV-uninfected patients. this timing reaction also closely temporally related initiation than treatment initiation. Focal diffuse lymph node enlargement is commonly described feature literature. Eye disease presentation CMV-IRIS. existing data suggest majority develop IRIS have good long-term clinical outcomes, partially due immunological viral response ART.