title: Immune reconstitution inflammatory syndrome in HIV-infected patients.
abstract: Access to antiretroviral therapy (ART) is improving worldwide. Immune reconstitution inflammatory syndrome (IRIS) is a common complication of ART initiation. In this review, we provide an overview of clinical and epidemiological features of HIV-associated IRIS, current understanding of pathophysiological mechanisms, available therapy, and preventive strategies. The spectrum of HIV-associated IRIS is described, with a particular focus on three important pathogen-associated forms: tuberculosis-associated IRIS, cryptococcal IRIS, and Kaposi's sarcoma IRIS. While the clinical features and epidemiology are well described, there are major gaps in our understanding of pathophysiology and as a result therapeutic and preventative strategies are suboptimal. Timing of ART initiation is critical to reduce IRIS-associated morbidity. Improved understanding of the pathophysiology of IRIS will hopefully enable improved diagnostic modalities and better targeted treatments to be developed.
authors.affiliation: Department of Medicine, Imperial College London, London, UK ; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa ; Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Naomi F
authors.initials: NF
authors.lastname: Walker
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa ; Department of Medicine, University of Cape Town, Cape Town, South Africa ; Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: James
authors.initials: J
authors.lastname: Scriven
authors.affiliation: Department of Medicine, Imperial College London, London, UK ; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa ; Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Department of Medicine, Imperial College London, London, UK ; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa ; MRC National Institute of Medical Research, London, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
keywords: IRIS; antiretroviral therapy; complications; diagnosis; tuberculosis