Immune reconstitution inflammatory syndrome

Abstract

Antiretroviral therapy (ART) inhibits HIV replication, allowing recovery of CD4+ T cell numbers and the restoration of immune function; its introduction has led to improved outcomes for individuals with HIV infection. However, it has been observed that some individuals responding to ART experience a clinical deterioration with symptoms and signs of an inflammatory illness. Immune reconstitution inflammatory syndrome (IRIS) results from pathological immune responses occurring during immune reconstitution. IRIS is best considered a group of disorders with a wide range of clinical manifestations, incorporating disease resulting from pathological inflammation to pathogens, immune-mediated inflammatory disease and autoimmune disease. Clinical effects range from a mild, self-limiting illness to severe morbidity and mortality. Clinicians working in the field of HIV medicine can expect to encounter individuals with IRIS. In this review, we discuss definitions, describe clinical presentations, summarize research relating to pathogenesis and identify risk factors, preventive and management strategies.

Kidney failure during HIV disease treated with tenofovir, multiple concurrent diseases and drug therapies

“…However, an increasingly modified disease presentation, which may lead to a true "pathomorphism" of infectious, neoplastic, and other HIV-related and AIDS-related and unrelated disorders in an increasing number of cases, has been recognized just since the cART era. As known, this relevant phenomenon has emerged in parallel with the use of effective and potent cART regimens, and it may be attributable to a very extensive number and variety of concurrent, and not always independent factors and co-factors [8,[12][13][14][15][16][17][18][19][20], including immune recovery achieved just thanks to cART itself [21,22], and worldwide epidemiological changes (due to huge immigration flows, for example) [23]. At the same time, the number of "AIDS presenters", i.e.…”

“…cigarette smoking, illicit or recreational drugs use, alcohol intake, lack of an appropriate diet and physical exercise, i.e. a broad series of "unmodifiable" and "modifiable" risk factors for cardiocerebrovascular damage and other potentially severe end-organ disorders among HIV-infected patients, as known since many years [8,10,61,[66][67][68]; • the progressively increased mean age of the entire population living with HIV, which unavoidably predisposes to further comorbidities and to an exponential increase of nested disorders, as well as the expected cumbersome problems linked to their prevention, monitoring, and management in the daily clinical practice of physicians engaged in the care of people affected by HIV disease, even more during the third millennium [4,5,7,8,10,18,[19][20][21][22]27,28,[34][35][36][41][42][43]61,69,70]; • the genetic background of patients, taken as racial-and gender-related issues, and individual features, which may influence and affect all the above-mentioned causes and correlations [10,18,21,22,[70][71][72][73][74][75].…”

Síndrome de restauração imune associada à histoplasmose

“…A reduction in viral replication and an increase in the number of CD4+ T cells is observed in patients on HAART. 8 However, in a significant number of patients, immune recovery can induce IRIS. 8,9 The condition is reported in 15-25% of patients on HAART and probably has a greater prevalence (30-45%) in those with a pre-existing opportunistic infection.…”

“…8 However, in a significant number of patients, immune recovery can induce IRIS. 8,9 The condition is reported in 15-25% of patients on HAART and probably has a greater prevalence (30-45%) in those with a pre-existing opportunistic infection. 10,11 According to Lehloenya & Meintjes (2006), 52% to 78% of patients with IRIS can have dermatological manifestations.…”

Manifestações orais associadas ao HIV após 30 anos de epidemia no Brasil

“…Está associada a muitas patologias como micobacterioses, criptococose, SK, linfoma não-Hodgkin e doenças não associadas à aids, como doenças reumáticas. Sua incidência varia entre 10 a 50% dos pacientes que iniciaram a HAART (Elston;Thaker, 2009;Müller et al, 2010 meses após a alta hospitalar, a lesão reapareceu e a falta de continuidade no uso da HAART parece ter tido papel importante neste processo. 10-Carga viral superior a 100 mil cópias.…”