Immune reconstitution inflammatory syndrome: the trouble with immunity when you had none.
Some individuals who are infected with HIV rapidly deteriorate shortly after starting antiretroviral therapy, despite effective viral suppression. This reaction, referred to as immune reconstitution inflammatory syndrome (IRIS), is characterized by tissue-destructive inflammation and arises as CD4(+) T cells re-emerge. It has been proposed that IRIS is caused by a dysregulation of the expanding population of CD4(+) T cells specific for a co-infecting opportunistic pathogen. Here, we argue that IRIS instead results from hyper-responsiveness of the innate immune system to T cell help, a mechanism that may be shared by the many manifestations of IRIS that occur following the reversal of other types of immunosuppression in pathogen-infected hosts.
Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rm 6146, 50 South Drive, Bethesda, Maryland, 20892, USA. barberd@niaid.nih.gov
Daniel L
DL
Barber
Bruno B
BB
Andrade
Irini
I
Sereti
Alan
A
Sher
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D004195:Disease Models, Animal; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology* / Q000276:immunology; D007108:Immune Tolerance / Q000276:immunology; D007113:Immunity, Innate / Q000276:immunology / Q000502:physiology; D008231:Lymphopenia / Q000276:immunology; D051379:Mice; D018448:Models, Immunological; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000276:immunology; D000069442:Natalizumab; D012307:Risk Factors
D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab