The immune reconstitution inflammatory syndrome: a cause of death in persons on antiretroviral therapy?
The availability of antiretroviral therapy (ART) has significantly improved the quality of life of persons with HIV infection. However, new problems have arisen as a consequence of this treatment. An immune reconstitution inflammatory syndrome (IRIS) in which patients experience a paradoxical worsening of their clinical condition may occur during recovery of the immunity. Thus far, there is no laboratory test available to diagnose IRIS. The diagnosis therefore remains clinical and by exclusion. In this paper, we describe the autopsy findings of three HIV-infected patients who died at the Antwerp University hospital directly or indirectly related to IRIS. One patient died following a disseminated cryptococcocal and Mycobacterium avium complex (MAC) infection. Two other patients died with a disseminated aspergillosis infection after receiving corticosteroids to decrease IRIS induced inflammatory signs. These three patients show the difficulties faced by clinicians in diagnosing IRIS and the importance of performing autopsies in persons with HIV infection who die despite receiving ART.
Department of Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium. dhuisintveld@itg.be
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Huis in 't Veld
Department of Pathology, Mulago Hill Road, College of Health Sciences, Makerere University, Kampala, Uganda.
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Lukande
Department of Pathology, Antwerp University Hospital, Edegem, Belgium.
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Lammens
Department of Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium.
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Conesa-Botella
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
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Vlieghe
Department of Pathology, Antwerp University Hospital, Edegem, Belgium.
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Van Marck
Department of Pathology, Antwerp University Hospital, Edegem, Belgium.
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Pauwels
Department of Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium.
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Colebunders
D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001228:Aspergillosis / Q000150:complications; D003453:Cryptococcosis / Q000150:complications; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications