Immune reconstitution disease associated with parasitic infections following initiation of antiretroviral therapy.
OBJECTIVE
The aim of this article is to review the literature concerning immune reconstitution disease associated with parasitic infections during antiretroviral therapy.


RESULTS
Immune reconstitution disease is most commonly associated with mycobacterial, chronic viral and invasive fungal infections. The spectrum of infections recognized to be associated with this phenomenon is expanding, however, and now includes a number of parasite infections (protozoal and helminthic). A total of 24 suspected cases have been reported in association with the following diseases: leishmaniasis in its various forms (visceral, cutaneous, mucosal and post-kala-azar dermal leishmaniasis), toxoplasmosis, cryptosporidiosis, schistosomiasis and strongyloidiasis. All cases associated with helminthic infections (schistosomiasis and strongyloidiasis) occurred in immigrants from tropical countries living in high-income countries; four of the patients with leishmaniasis were either immigrants or migrants who had moved out of endemic areas. As access to antiretroviral therapy expands in resource-limited settings, the clinical spectrum, frequency and impact of immune reconstitution disease associated with parasitic infections must be defined.


CONCLUSIONS
Reports of immune reconstitution disease associated with parasitic infections are increasing, with many occurring in immigrants or migrants from areas where these diseases are endemic. The importance of such cases in antiretroviral therapy programmes in resource-limited settings, however, is not yet known.
Lawn
Stephen D
SD
The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. stevelawn@yahoo.co.uk
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology* / Q000276:immunology*; D010272:Parasitic Diseases / Q000150:complications / Q000276:immunology* / Q000469:parasitology
D019380:Anti-HIV Agents