Immune reconstitution inflammatory syndrome: Difference between revisions
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*Progressive Multifocal Leukoencephalopathy- worsening focal neuro lesions, changes on MRI | *Progressive Multifocal Leukoencephalopathy- worsening focal neuro lesions, changes on MRI | ||
*Kaposi's Sarcoma- worsening Kaposi's | *Kaposi's Sarcoma- worsening Kaposi's | ||
*Autoimmune diseases- | *Autoimmune diseases- Pre-existing autoimmune disorder exacerbation | ||
===Minor Presentations=== | ===Minor Presentations=== | ||
Revision as of 17:35, 31 July 2015
Background
- Also called IRIS
- Definition-Disease or pathogen specific inflammatory response in HIV infected patients after initiation or re-initiation of ARV therapy or after change to more active ARV therapy.
- Usually low CD4 counts and high viral loads at time of ARV initiation
- Can occur at any CD4 count
- Occurs usually within 4-8 weeks after initiation of therapy
Clinical Features
Major Presentations
- TB- worsening TB symptoms
- MAC- localized lymphadenitis, pulm disease, systemic inflammation indistinguishable from active MAC
- MAC-IRIS patients are not bacteremic
- Crypto- worsening meningitis symptoms
- CMV-Retinitis, Vitritis, Uveitis
- IRIS due to CMV can cause vision loss
- mean time to vitritis 20 weeks
- IRIS due to CMV can cause vision loss
- Hepatitis B or C- transient transaminitis difficult to distinguish from drug induced cause
- hepatic flares usually mild, may decompensate cirrhotics.
- Progressive Multifocal Leukoencephalopathy- worsening focal neuro lesions, changes on MRI
- Kaposi's Sarcoma- worsening Kaposi's
- Autoimmune diseases- Pre-existing autoimmune disorder exacerbation