CO-INFECTIONS (C BENSON, SECTION EDITOR) Management of the Immune Reconstitution Inflammatory Syndrome Graeme Meintjes & James Scriven & Suzaan Marais Published online: 3 July 2012 # Springer Science+Business Media, LLC 2012 Abstract The immune reconstitution inflammatory syn- drome (IRIS) is a frequent early complicati on of antiretroviral therapy (ART) in patients with advanced HIV. Because there is no confirmatory diagnostic test, the diagnosis is based on clinical presentation and exclusion of alternative causes for deterioration, such as antimicrobial drug resistance. Opportu- nistic infection treatment should be optimized. Mild cases may require symptomatic therapy alone or nonsteroidal anti- inflammatory drugs. Corticosteroids have been used to treat more severe cases of IRIS associated with mycobacterial and fungal infections. There is evidence from a randomized con- trolled trial that prednisone reduces morbidity and improves symptoms in paradoxical tuberculosis (TB)-IRIS. Neurologi- cal TB-IRIS is potentially life-threatening; high-dose cortico- steroids are indicated and ART interr uption should be considered if level of consciousness is depressed. When con- sidering corticostero id treatment cl inicians sh ould be aware of their side effects and only use them when the diagnosis of IRIS is certain. In viral forms of IRIS corticosteroids are generally avoided. Keywords HIV . AIDS . Antiretr oviral therap y . Immune recons titution inflammatory syndr ome . Tuberculosis . Cryptococcosis . Mycob acterial disease . Cytomegalovirus . Kaposi’s sar coma . Progre ssive multifo cal leukoencephalopathy . Vir al hepati tis . Corticosteroids Introduction During early antiretroviral therapy (ART) a proportion of patients experience deterioration due to the immune recon- stitution infla mmatory synd rome (IRIS). This proportion has been up to 25 % in some series [ 1 – 3]. IRIS manifests with inflammatory reactions, targete d at the antigens of opportunistic infections (OIs) driven by rapidly recovering G. Meintje s : J. Scrive n : S. Marais Clinical Infectious Diseases Research Initiative, Instit ute of Infec tious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa J. Scrive n e-mail: [email protected] S. Marais e-mail: [email protected] G. Meintje s Division of Infec tious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa G. Meintje s GF Jooste Hospital, Cape Town, South Africa G. Meintjes Department of Medicine, Imperial College London, London , UK J. Scrive n Liverpool School of Tropical Medicine, Liverpool University, Liverpool, UK S. Marais Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa G. Meintj es (*) : J. Scriven : S. Marais Instit ute of Infect ious Diseases and Molecu lar Medicine, Facult y of Health Scienc es, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa e-mail: [email protected] Curr HIV/AIDS Rep (2012) 9:238 – 250 DOI 10.1007/s11904-012-0129-5
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 1/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 2/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 3/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 4/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 5/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 6/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 7/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 8/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 9/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 10/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 11/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 12/13
8/12/2019 10.1007_s11904-012-0129-5
http://slidepdf.com/reader/full/101007s11904-012-0129-5 13/13
Related Documents
