title: Pulmonary manifestations of the immune reconstitution inflammatory syndrome.
abstract: OBJECTIVE
  Immune reconstitution inflammatory syndrome (IRIS) is a common occurrence in HIV patients starting antiretroviral therapy (ART), and pulmonary involvement is an important feature of tuberculosis-IRIS and pneumocystis-IRIS. Pulmonologists need an awareness of the timing, presentation and treatment of pulmonary IRIS.
  
  
  RESULTS
  Case definitions for tuberculosis-IRIS and cryptococcal-IRIS have been published by the International Network for the Study of HIV-associated IRIS (INSHI). A number of studies have addressed validation of clinical case definitions and the optimal time to commence ART after diagnosis of an opportunistic infection in HIV patients. The pathogenesis of IRIS is being assessed at a molecular level, increasing our understanding of mechanisms and possible targets for future preventive and therapeutic strategies.
  
  
  CONCLUSIONS
  Tuberculosis-IRIS, nontuberculosis mycobacterial-IRIS and pneumocystis-IRIS occur within days to weeks of starting ART, causing substantial morbidity, but low mortality. Cryptococcal-IRIS usually occurs later in the course of ART, and may be associated with appreciable mortality. Early recognition of unmasking and paradoxical IRIS affecting the lung allows timely initiation of antimicrobial and/or immunomodulatory therapies.
authors.affiliation: Division of Pulmonology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Gregory
authors.initials: G
authors.lastname: Calligaro
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.forename: Marc
authors.initials: M
authors.lastname: Mendelson
mesh_terms: D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications*; D016720:Pneumocystis Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*
chemical_list: D044966:Anti-Retroviral Agents; D005938:Glucocorticoids; D011241:Prednisone