Immune reconstitution syndrome: Difference between revisions
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===Commonly Associated Pathogens=== | ===Commonly Associated Pathogens=== | ||
*[[Mycobacterium tuberculosis]] | *[[Mycobacterium tuberculosis]] | ||
*[[Mycobacterium avium | *[[Mycobacterium avium]] | ||
*[[Cytomegalovirus]] | *[[Cytomegalovirus]] | ||
*[[Cryptococcus neoformans]] | *[[Cryptococcus neoformans]] | ||
*[[ | *[[Pneumocystis jirovecii]] | ||
*[[Herpes simplex virus]] | *[[Herpes simplex virus]] | ||
*[[Hepatitis B | *[[Hepatitis B]]<ref>Shelburne SA 3rd, Hamill RJ, Rodriguez-Barradas MC, et al. Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore). 2002;81(3):213–227. doi:10.1097/00005792-200205000-00005</ref> | ||
==Management== | ==Management== | ||
Revision as of 15:22, 24 March 2020
Background
Immune reconstitution syndrome, or immune reconstitution inflammatory syndrome (IRIS), refers to the paradoxical worsening of pre-existing infections after antiretroviral therapy (ART) is intiated for HIV.[1] It occurs due to increases in T lymphocyte numbers that occurs after ART is started as well as increased immune response.
Clinical Features
Differential Diagnosis
Evaluation
Diagnostic Criteria
The diagnosis of IRIS is clinical. Most of the following criteria should be present to make the diagnosis:[2]
- Presence of AIDS with low pretreatment CD4 count. Usually this is <100, but tuberculosis can be reactivated with CD4 cells >200.
- Positive virologic and immunologic response to ART
- Absence of evidence of drug-resistant infection, bacterial superinfection, adverse drug reaction, patient noncompliance, or reduced serum drug levels
- Presence of clinical manifestations consistent with inflammatory condition
- Temporal association between ART initiation and the onset of clinical features of illness
Commonly Associated Pathogens
- Mycobacterium tuberculosis
- Mycobacterium avium
- Cytomegalovirus
- Cryptococcus neoformans
- Pneumocystis jirovecii
- Herpes simplex virus
- Hepatitis B[3]
Management
Disposition
See Also
External Links
References
- ↑ DeSimone JA, Pomerantz RJ, Babinchak TJ. Inflammatory reactions in HIV-1-infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med. 2000;133(6):447–454. doi:10.7326/0003-4819-133-6-200009190-00013
- ↑ Haddow LJ, Easterbrook PJ, Mosam A, et al. Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis. 2009;49(9):1424–1432. doi:10.1086/630208
- ↑ Shelburne SA 3rd, Hamill RJ, Rodriguez-Barradas MC, et al. Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore). 2002;81(3):213–227. doi:10.1097/00005792-200205000-00005