Update on immune reconstitution inflammatory syndrome: Progress and unanswered questions

Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, 341 Ponce de Leon Avenue, Atlanta, GA 30308, USA.
Current Infectious Disease Reports (Impact Factor: 1.68). 11/2009; 11(6):486-93. DOI: 10.1007/s11908-009-0070-y
Source: PubMed


The immune reconstitution inflammatory syndrome (IRIS) is characterized by clinical deterioration occurring after the initiation of effective antiretroviral therapy (ART) and results from a disordered and exuberant immune response. The syndrome may present as paradoxical IRIS or unmasking IRIS, depending on whether an opportunistic infection was recognized and treated before ART initiation. Numerous descriptions of IRIS caused by many pathogens were published in the years after the introduction of effective ART. In recent years, with enhanced rollout of ART in resource-limited settings, attention has again focused on IRIS because of the enormous burden of opportunistic infections. This review highlights recent findings elucidating risk factors for and the pathogenesis and treatment of IRIS.

6 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite advances in human immunodeficiency virus (HIV) treatment and discovery of effective prevention programs, HIV infection in American youth continues to rise, especially in minority youth. The crisis underscores the lack of access to care and wellness of our adolescent and young adult populations. Primary care practitioners who care for young adults will diagnose and/or encounter HIV-infected patients in their practice. Providers need to become familiar with the basics of HIV prevention and treatment, as well as how adolescence presents unique challenges in HIV care.
    No preview · Article · Aug 2010 · Adolescent medicine: state of the art reviews
  • [Show abstract] [Hide abstract]
    ABSTRACT: The introduction of antiretroviral therapies has changed the pattern of cutaneous disease in individuals infected with human immunodeficiency virus (HIV). To assess demographic characteristics, severity of immunosuppression, and frequency of dermatologic disorders in patients presenting to a Canadian specialized HIV dermatology practice. A cross-sectional study was performed of 183 consecutive outpatient and inpatient consultations to a single HIV dermatology practice from January 2007 to December 2008. One hundred sixty-three (88%) patients were male, with an average age of 45. Forty-six patients were not on antiretroviral therapy. Verruca was the most common diagnosis, seen in 29 patients, followed by dermatophyte infection, seen in 27. Patients with a low CD4 count (p  =  .0001) and a high viral load (p  =  .0043) were more likely to present with an HIV-specific dermatosis. Cutaneous infections were the most common diagnoses in this cross section. Classic HIV dermatoses were seen more frequently in those with more advanced disease owing to HIV infection.
    No preview · Article · May 2011 · Journal of Cutaneous Maedicine and Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: The immune reconstitution inflammatory syndrome (IRIS) is a well-described phenomenon in HIV-infected patients following initiation of antiretroviral therapy and can lead to significant morbidity and mortality in some patients. Risk for IRIS is enhanced in those with low CD4 counts and preexisting opportunistic infections. The development of pathogen-specific definitions of IRIS has aided classification of patients and has facilitated research. Newer data on optimal timing of ART initiation, with additional data in the setting of tuberculosis and cryptococcal meningitis, will help guide strategies to decrease the risk of IRIS but must balance the risks of HIV disease progression. Managing patients with IRIS can be challenging. Treatment options include pathogen-specific therapy, antiinflammatory therapies, and other novel approaches.
    No preview · Article · Dec 2012 · Current Infectious Disease Reports
Show more