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Immune reconstitution inflammatory syndrome in HIV-infected patients

Authors Walker NF, Scriven J, Meintjes G, Wilkinson RJ

Received 8 May 2014

Accepted for publication 26 June 2014

Published 12 February 2015 Volume 2015:7 Pages 49—64

DOI https://doi.org/10.2147/HIV.S42328

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2


Naomi F Walker,1–3 James Scriven,2–4 Graeme Meintjes,1–3 Robert J Wilkinson1,2,5

1Department of Medicine, Imperial College London, London, UK; 2Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; 3Department of Medicine, University of Cape Town, Cape Town, South Africa; 4Liverpool School of Tropical Medicine, Liverpool, UK; 5MRC National Institute of Medical Research, London, UK

Abstract: Access to antiretroviral therapy (ART) is improving worldwide. Immune reconstitution inflammatory syndrome (IRIS) is a common complication of ART initiation. In this review, we provide an overview of clinical and epidemiological features of HIV-associated IRIS, current understanding of pathophysiological mechanisms, available therapy, and preventive strategies. The spectrum of HIV-associated IRIS is described, with a particular focus on three important pathogen-associated forms: tuberculosis-associated IRIS, cryptococcal IRIS, and Kaposi's sarcoma IRIS. While the clinical features and epidemiology are well described, there are major gaps in our understanding of pathophysiology and as a result therapeutic and preventative strategies are suboptimal. Timing of ART initiation is critical to reduce IRIS-associated morbidity. Improved understanding of the pathophysiology of IRIS will hopefully enable improved diagnostic modalities and better targeted treatments to be developed.

Keywords: antiretroviral therapy, tuberculosis, IRIS, diagnosis, complications

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