Immune reconstitution disease: recent developments and implications for antiretroviral treatment in resource-limited settings

Lawn, Stephen D.; French, Martyn A.

doi:10.1097/coh.0b013e3281a3c0a6

Cited by 20 publications

(13 citation statements)

References 53 publications

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“…As predicted [4], IRD has become a significant complication of ART in HIV-infected patients from resourcepoor countries [42], particularly in those patients who are also infected with M. tuberculosis. IRD associated with previously treated M. tuberculosis infection is commonly known as tuberculosis IRIS and has a variety of clinical presentations, including pneumonitis, lymphadenitis, ileitis, hepatitis, suppurating masses, and serous effusions [11,12,[42][43][44][45]. Use of health care resources to manage tuberculosis IRIS is a substantial problem, but mortality is uncommon, with death occurring in ∼1% of patients [11,44].…”

Section: Irdmentioning

confidence: 99%

Immune Reconstitution Inflammatory Syndrome: A Reappraisal

2009

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Individuals with human immunodeficiency virus infection who commence antiretroviral therapy when they are very immunodeficient are susceptible to immune reconstitution disorders. The most common disorders are the various forms of immune restoration disease (IRD) that appear to result from the restoration of a dysregulated immune response against pathogen-specific antigens. Essentially, any pathogen that can cause an opportunistic infection as a result of cellular immunodeficiency can provoke IRD when pathogen-specific immune responses recover during antiretroviral therapy. In resource-poor countries, Mycobacterium tuberculosis and Cryptococcus neoformans are the most significant pathogens, because the former causes substantial morbidity and the latter causes substantial mortality. IRD associated with these pathogens is characterized by severe inflammatory responses and is often referred to as immune reconstitution inflammatory syndrome. Prevention and treatment strategies for IRD are being developed, but preliminary data have demonstrated the efficacy of corticosteroid therapy in severe cases. Immune reconstitution after antiretroviral therapy may also be associated with autoimmune disease or sarcoidosis, both of which appear to have an immunopathogenesis that is different from that of IRD.

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Section: Irdmentioning

confidence: 99%

Immune Reconstitution Inflammatory Syndrome: A Reappraisal

2009

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“…The combination of decreasing viral load [42] and mobilization of previously formed memory cells allows for the restoration of a specific response against mycobacterial antigens, one that can be a rapid, inflammatory, and necrotizing delayed-type hypersensitivity response with granulomatous inflammation and suppuration [26,43]. T suppressor cells and the balance between effector and suppressor cell-mediated responses have been postulated to play an important role in the development of IRIS [44].…”

Section: May Be Due To Unrecognized or Unmasked Tb And/or Other Diseamentioning

confidence: 99%

Unmasked Tuberculosis and Tuberculosis Immune Reconstitution Inflammatory Disease: A Disease Spectrum after Initiation of Antiretroviral Therapy

et al. 2009

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Antiretroviral therapy (ART) has beneficial effects on mortality and lowers the incidence of diseases caused by opportunistic infections, such as tuberculosis (TB). Although ART has sustained long-term benefits, the risk of TB is high during the first 3 months after ART initiation. Among cases of ART-associated TB, we define "unmasked TB" as that which occurs in patients with reactivation disease who develop clinically recognizable TB after ART with the restoration of previously acquired TB antigen-specific functional immune responses. TB cases with clinical evidence of an inflammatory syndrome are a subset of these unmasked cases, which we define as "unmasked TB-immune reconstitution inflammatory syndrome." With more widespread use of ART in areas with a high prevalence of TB, unmasked TB will likely become more common. TB diagnostics with improved sensitivity and specificity are urgently needed to detect subclinical TB before it is unmasked.

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“…First, although the prevalence of HIV-related opportunistic ocular infections [such as cytomegalovirus (CMV) retinitis] has decreased, 21 the introduction and scaleup of ART has led to immune recovery phenomena. 22 This may manifest in the eye as "immune recovery uveitis" (IRU). It is characterized by ocular inflammation after ART initiation and can lead to cataract formation.…”

Section: Introductionmentioning

confidence: 99%

Increased Ocular Lens Density in HIV-Infected Individuals With Low Nadir CD4 Counts in South Africa

Pathai¹,

Lawn²,

Weiss³

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Immune reconstitution disease: recent developments and implications for antiretroviral treatment in resource-limited settings

Abstract: While immune reconstitution disease in high-income countries has been clinically and epidemiologically well described, much remains to be learned in resource-limited settings in which immune reconstitution disease is emerging as a significant cause of morbidity and mortality.

Cited by 20 publications

References 53 publications

Immune Reconstitution Inflammatory Syndrome: A Reappraisal

Immune Reconstitution Inflammatory Syndrome: A Reappraisal

Unmasked Tuberculosis and Tuberculosis Immune Reconstitution Inflammatory Disease: A Disease Spectrum after Initiation of Antiretroviral Therapy

Increased Ocular Lens Density in HIV-Infected Individuals With Low Nadir CD4 Counts in South Africa

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