PMID- 26303886
OWN - NLM
STAT- MEDLINE
DCOM- 20160524
LR  - 20151217
IS  - 1878-1810 (Electronic)
IS  - 1878-1810 (Linking)
VI  - 167
IP  - 1
DP  - 2016 Jan
TI  - Therapeutics targeting inflammation in the immune reconstitution inflammatory 
      syndrome.
PG  - 88-103
LID - S1931-5244(15)00258-3 [pii]
LID - 10.1016/j.trsl.2015.07.010 [doi]
AB  - Immune reconstitution inflammatory syndrome (IRIS) is characterized by 
      improvement in a previously incompetent human immune system manifesting as 
      worsening of clinical symptoms secondary to the ability of the immune system to 
      now mount a vigorous inflammatory response. IRIS was first recognized in the 
      setting of human immunodeficiency virus, and this clinical setting continues to 
      be where it is most frequently encountered. Hallmarks of the pathogenesis of 
      IRIS, independent of the clinical presentation and the underlying pathogen, 
      include excessive activation of the immune system, with increased circulating 
      effector memory T cells, and elevated levels of serum cytokines and inflammatory 
      markers. Patients with undiagnosed opportunistic infections remain at risk for 
      unmasking IRIS at the time of active antiretroviral therapy (ART) initiation. 
      Systematic screening for opportunistic infections before starting ART is a key 
      element to prevent this phenomenon. Appropriate management of IRIS requires 
      prompt recognition of the syndrome and exclusion of alternative diagnoses, 
      particularly underlying infections and drug resistance. Controlled studies 
      supporting the use of pharmacologic interventions in IRIS are scare, and 
      recommendations are based on case series and expert opinions. The only controlled 
      trial published to date, showed reduction in morbidity in patients with 
      paradoxical tuberculosis-related IRIS with the use of oral corticosteroids. There 
      are currently limited data to recommend other anti-inflammatory or 
      immunomodulatory therapies that are discussed in this review, and further 
      research is needed. Ongoing research regarding the immune pathogenesis of IRIS 
      will likely direct future rational therapeutic approaches and clinical trials.
CI  - Published by Elsevier Inc.
FAU - Shahani, Lokesh
AU  - Shahani L
AD  - Section of Infectious Diseases, Department of Medicine, Baylor College of 
      Medicine, Houston, Tex.
FAU - Hamill, Richard J
AU  - Hamill RJ
AD  - Section of Infectious Diseases, Department of Medicine, Baylor College of 
      Medicine, Houston, Tex; Medical Care Line, Section of Infectious Diseases, 
      Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex. Electronic 
      address: rhamill@bcm.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20150807
PL  - United States
TA  - Transl Res
JT  - Translational research : the journal of laboratory and clinical medicine
JID - 101280339
RN  - 0 (Anti-Inflammatory Agents)
SB  - IM
MH  - Anti-Inflammatory Agents/*therapeutic use
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*drug therapy/etiology
MH  - *Immunomodulation
MH  - Inflammation/*drug therapy
MH  - Risk Factors
EDAT- 2015/08/26 06:00
MHDA- 2016/05/25 06:00
CRDT- 2015/08/26 06:00
PHST- 2015/03/30 00:00 [received]
PHST- 2015/07/14 00:00 [revised]
PHST- 2015/07/31 00:00 [accepted]
PHST- 2015/08/26 06:00 [entrez]
PHST- 2015/08/26 06:00 [pubmed]
PHST- 2016/05/25 06:00 [medline]
AID - S1931-5244(15)00258-3 [pii]
AID - 10.1016/j.trsl.2015.07.010 [doi]
PST - ppublish
SO  - Transl Res. 2016 Jan;167(1):88-103. doi: 10.1016/j.trsl.2015.07.010. Epub 2015 
      Aug 7.