Immune reconstitution inflammatory syndrome in HIV-infected patients

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

Acknowledgments

This work was supported by the Medical Research Council (U1175.02.002.00014.01), Wellcome Trust (references 084323, 088316, 094000, 094013, and 098316), and the European Union (PIRSES-GA-2011-295214, and FP7 HEALTH-F3-2012-305578). Graeme Meintjes was supported in part by the National Research Foundation (NRF) of South Africa [UID: 85858]. The grant holders acknowledge that opinions, findings, and conclusions or recommendations expressed in any publication generated by the NRF-supported research are those of the authors, and that the NRF accepts no liability whatsoever in this regard.

Disclosure

The authors report no conflicts of interest in this work.