[Immune reconstitution syndrome and mycobacterial disease during highly active antiretroviral therapy. Retrospective study of six cases].
BACKGROUND
Soon after starting highly active antiretroviral therapy (HAART), some patients experience clinical deterioration due to the reactivation of their immune system. Mycobacteria are the principal agents complicating this immune reconstitution period.


METHODS
A retrospective examination of patients with mycobacterial disease before or shortly after beginning HAART at Grenoble University Hospital from January 2001 through July 2004 identified six subjects (among 650 outpatients per year) with a new or aggravated mycobacterial disease after starting HAART. Clinical manifestations were: adenopathy (4/6), hyperthermia (3/6), thoracic pain (2/6), abscess (2/6), and neurological deterioration (1/6).


CONCLUSIONS
Severely immunosuppressed patients who begin HAART may reactivate or aggravate a mycobacterial disease such as tuberculosis. In such cases, current recommendations call for continuing HAART, beginning or continuing the antimycobacterial therapy, and considering corticosteroids on a case-by-case basis. For patients with AIDS, opportunistic infections that might be reactivated should be actively sought before HAART.
Méan
M
M
Maladies infectieuses, Département de médecine aiguë et spécialisée, Centre hospitalier universitaire de Grenoble, La Tronche.
Pavese
P
P
Blanc
M
M
Leclercq
P
P
Brion
J-P
JP
Stahl
J-P
JP
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology* / Q000382:microbiology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy / Q000276:immunology*
D000995:Antitubercular Agents