Immune Reconstitution Inflammatory Syndrome in Hiv Infection

Abstract

Antiretroviral therapy (ART) leads to suppression of HIV replication, contributes to increase in the number of CD4-lymphocytes count and partial restoration or activation of the immune system. The consequence is a reduction of incidence of opportunistic diseases, increase in the duration and quality of life of people living with HIV (PLHIV). However, in some patients with severe immunosuppression, this may be accompanied by a worsening of the condition and risks of formation of the immune reconstitution inflammatory syndrome (IRIS), which manifests itself in the development of new or previously treated opportunistic, secondary and exacerbating non- infectious diseases against a virologically effective ART. The frequency of the development of IRIS varies widely, in cases of tuberculosis-associated manifestation it can reach 50%. Risk factors for the development of IRIS are low initial CD4-lymphocyte count and a high load of HIV RNA in the blood, the presence of opportunistic infections during the initiation of ART. Discussed terminology issues, other possible risk factors for the development of the syndrome, regularities of the pathological process are considered. Epidemiological statistics of IRIS, pathogenetic bases, variants of clinical and laboratory manifestations of complications are given. The criteria for diagnosis of the syndrome, as well as the necessary conditions for its occurrence, are considered. Particular attention is paid to the most common opportunistic infections that cause the manifestation of IRIS, the peculiarities and polymorphism of clinical manifestations and the prevention of their occurrence. Currently, there is an increasing incidence of HIV infection in the late stages. Laboratory and clinical differences in the manifestations of acquired immunodeficiency syndrome (AIDS) and IRIS have been sanctified. In view of the blurring of the diagnostic criteria, in the Russian Federation specialists rarely expose IRIS to clinical or pathological diagnoses, therefore it is rather difficult to trace the frequency of occurrence of this condition. Clinical and laboratory manifestations are systematized, which allows to formulate this diagnosis on the basis of their totality. Prevention of IRIS is the prudent prescription of antiretroviral drugs. It is neces sary to conduct a qualitative and timely diagnosis of concomitant diseases of infectious and non-infectious nature before the initiation of ART and during treatment, the appointment of effective etiotropic therapy for opportunistic and secon dary infections. In order to improve the prognosis of HIV infection, preferably early onset of ART with stable CD4-lym phocyte counts and low HIV RNA levels in the blood.