PMID- 12876896
OWN - NLM
STAT- MEDLINE
DCOM- 20030822
LR  - 20051116
IS  - 1139-6121 (Print)
IS  - 1139-6121 (Linking)
VI  - 5
IP  - 2
DP  - 2003 Apr-Jun
TI  - The immune reconstitution inflammatory syndrome.
PG  - 67-79
AB  - The use of highly active antiretroviral therapy (HAART) has led to a substantial 
      decrease in the frequency of opportunistic infections among HIV-infected 
      individuals, along with a significant reduction in their mortality rate. However, 
      a subgroup of HAART-treated patients will exhibit paradoxical deterioration in 
      their clinical status, despite satisfactory control of viral replication and 
      improvements in CD4 lymphocyte counts. This clinical deterioration, known as the 
      immune restoration syndrome or immune reconstitution inflammatory syndrome 
      (IRIS), is a result of an exuberant inflammatory response towards previously 
      diagnosed or incubating opportunistic pathogens, as well as responses towards 
      other as yet undefined antigens. A variety of manifestations of IRIS have been 
      described, most prominently including Mycobacterium avium complex lymphadenitis, 
      paradoxical exacerbations of pulmonary and CNS Mycobacterium tuberculosis 
      infection, paradoxical exacerbations of Cryptococcus neoformans meningitis and 
      cytomegalovirus uveitis. Treatment for this disorder includes continuation of 
      primary therapy against the offending pathogen in order to decrease the antigenic 
      load, continuation of effective HAART, and judicious use of anti-inflammatory 
      agents. Although the clinical manifestations of IRIS are sometimes dramatic, and 
      result in substantial morbidity, the fact that these patients are capable of 
      generating an inflammatory response allows many of them to ultimately discontinue 
      secondary prophylaxis for the offending pathogen.
FAU - Shelburne, Samuel A 3rd
AU  - Shelburne SA 3rd
AD  - Section of Infectious Diseases (111G), Veterans Affairs Medical Center, 2002 
      Holcombe Blvd., Houston, Texas 77030-4211, USA.
FAU - Hamill, Richard J
AU  - Hamill RJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Spain
TA  - AIDS Rev
JT  - AIDS reviews
JID - 101134876
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/drug 
      therapy/immunology/*microbiology/virology
MH  - Anti-HIV Agents/therapeutic use
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - HIV Infections/*complications/drug therapy/*immunology/microbiology
MH  - Humans
MH  - Inflammation/*complications/*immunology/microbiology
MH  - Syndrome
RF  - 149
EDAT- 2003/07/25 05:00
MHDA- 2003/08/23 05:00
CRDT- 2003/07/25 05:00
PHST- 2003/07/25 05:00 [pubmed]
PHST- 2003/08/23 05:00 [medline]
PHST- 2003/07/25 05:00 [entrez]
PST - ppublish
SO  - AIDS Rev. 2003 Apr-Jun;5(2):67-79.