Immune reconstitution syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Symptoms of underlying illness within 1 week to a few months after initiating ART | |||
*Fever (especially with mycobacterial or cryptococcal infections) | |||
*Manifestations of the underlying disease process: | |||
**[[Tuberculosis]] | |||
**[[Mycobacterium avium]] | |||
**Cryptococcus | |||
**[[Cytomegalovirus]] | |||
*[[JC virus]] | |||
*[[Pneumocystis jirovecii pneumonia]] | |||
*[[Herpes zoster]] | |||
*[[Hepatitis B]] | |||
*[[Leishmaniasis]] | |||
*[[Kaposi sarcoma]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 15:34, 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
- Symptoms of underlying illness within 1 week to a few months after initiating ART
- Fever (especially with mycobacterial or cryptococcal infections)
- Manifestations of the underlying disease process:
- Tuberculosis
- Mycobacterium avium
- Cryptococcus
- Cytomegalovirus
- JC virus
- Pneumocystis jirovecii pneumonia
- Herpes zoster
- Hepatitis B
- Leishmaniasis
- Kaposi sarcoma
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