Evidence base for using corticosteroids to treat HIV-associated immune reconstitution syndrome.
Most of the evidence supporting the use of corticosteroids (steroids) for immune reconstitution syndrome (IRS) comes from case reports or retrospective series and is of low quality. However, when steroids are used, they have usually been associated with clinical improvement or resolution of IRS. Except in the case of hepatitis B- or C-associated IRS, there have been no reports of worsening of the IRS or adverse outcome due to steroid use. After ruling out other conditions which can mimic IRS, clinicians should strongly consider steroids when managing IRS associated with mycobacterial or fungal pathogens when there is severe disease, or when other measures have failed.
Lesho
Emil
E
Walter Reed Army Medical Center, Infectious Diseases, 11120 Nicholas Drive, Silver Spring, MD 20902, USA. emillesho@yahoo.com
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003453:Cryptococcosis / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000276:immunology; D009164:Mycobacterium Infections / Q000276:immunology; D016032:Randomized Controlled Trials as Topic; D013577:Syndrome
D000305:Adrenal Cortex Hormones