PMID- 22432669
OWN - NLM
STAT- MEDLINE
DCOM- 20120727
LR  - 20190902
IS  - 1326-5377 (Electronic)
IS  - 0025-729X (Linking)
VI  - 196
IP  - 5
DP  - 2012 Mar 19
TI  - Immune reconstitution inflammatory syndrome: immune restoration disease 20 years 
      on.
PG  - 318-21
AB  - Restoration of immune responses against opportunistic pathogens after commencing 
      antiretroviral therapy (ART) may cause immune restoration disease (IRD) in about 
      10%-40% of HIV patients with low CD4(+) T-cell counts and usually presents 
      clinically as a type of immune reconstitution inflammatory syndrome (IRIS). IRIS 
      may be associated with many different opportunistic pathogens, but types 
      associated with Mycobacterium tuberculosis, BCG, cryptococci, JC polyomavirus 
      (the cause of progressive multifocal leukoencephalopathy [PML]), hepatitis C 
      virus and hepatitis B virus infection are the most informative about disease 
      pathogenesis and management. A CD4(+) T-cell count of < 50/muL and a high pathogen 
      load are the most commonly identified risk factors for IRIS. Recovery of 
      pathogen-specific T-cell responses and perturbations of innate immune responses 
      before and after ART appear to cause immunopathological abnormality in tissues 
      infected by the pathogen. Prevention of IRIS may be influenced by the timing of 
      ART: The risk of tuberculosis (TB)-associated-IRIS can be reduced by commencing 
      ART after 8 weeks of TB treatment, but rates of AIDS or death are lower if ART is 
      commenced during the first 4 weeks of TB treatment. Outcomes for patients with 
      HIV and treated cryptococcal or TB meningitis may be improved by deferring ART 
      until the opportunistic infection is fully suppressed, but data are inadequate. 
      As ART is currently the only effective treatment for PML in patients with HIV, 
      PML-associated IRIS cannot be prevented by manipulating the timing of ART. A 
      greater understanding of the immunopathogenesis of IRIS may lead to targeted 
      therapies.
FAU - French, Martyn A H
AU  - French MA
AD  - School of Pathology and Laboratory Medicine, University of Western Australia, 
      Perth, WA, Australia. martyn.french@uwa.edu.au
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Med J Aust
JT  - The Medical journal of Australia
JID - 0400714
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*etiology
MH  - Anti-Retroviral Agents/*adverse effects/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Cryptococcosis/etiology/therapy
MH  - HIV Infections/complications/*drug therapy/immunology
MH  - Hepatitis B/etiology
MH  - Hepatitis C/etiology
MH  - Humans
MH  - *Immune Reconstitution Inflammatory Syndrome/etiology/therapy
MH  - Leukoencephalopathy, Progressive Multifocal/etiology
MH  - Tuberculosis/etiology/therapy
EDAT- 2012/03/22 06:00
MHDA- 2012/07/28 06:00
CRDT- 2012/03/22 06:00
PHST- 2012/01/13 00:00 [received]
PHST- 2012/02/20 00:00 [accepted]
PHST- 2012/03/22 06:00 [entrez]
PHST- 2012/03/22 06:00 [pubmed]
PHST- 2012/07/28 06:00 [medline]
AID - fre10089_fm [pii]
AID - 10.5694/mja12.10089 [doi]
PST - ppublish
SO  - Med J Aust. 2012 Mar 19;196(5):318-21. doi: 10.5694/mja12.10089.