[Immune reconstitution inflammatory syndrome and treatment of HIV infection].
BACKGROUND
HAART (highly active antiretroviral therapy) may trigger a condition known as IRIS (immune reconstitution inflammatory syndrome); i.e. a paradoxical reaction to latent infections associated with reconstitution of the immune system. The article provides an overview of the syndrome and discusses diagnosis, risk factors and management.


METHODS
The basis for the article was literature identified through non-systematic searches in PubMed and clinical experience.


RESULTS
IRIS typically occurs some weeks to months after initiation of HAART, usually in association with mycobacterial infections, cytomegalovirus, Cryptococcus neoformans and Pneumocystis jirovecii. In principle, any pathogen may cause a similar inflammatory response. Risk factors for IRIS include severe immunodeficiency, high antigen burden and rapid immune response to HAART. The prognosis is good. However, treatment of infections must not delay the initiation of HAART, as such a delay may increase morbidity and mortality. HAART should be continued unless symptoms are life-threatening or likely to cause permanent sequelae. Corticosteroids may be helpful in cases with lesions in the central nervous system, obstructive lymph nodes or increasing respiratory symptoms.


CONCLUSIONS
Treatment of HIV infection has improved substantially, which implies an increased number of patients developing IRIS. A quick diagnosis and correct and timely treatment of opportunistic infections is important for the prognosis.
Trøseid
Marius
M
Medisinsk avdeling, Oslo universitetssykehus, Ullevål og Leger Uten Grenser, Postboks 8813 Youngstorget, 0028 Oslo, Norway. troseid@hotmail.com
Eskesen
Arne
A
Bruun
Johan N
JN
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D011379:Prognosis; D012307:Risk Factors
D000893:Anti-Inflammatory Agents