3.30 MB - Academy of Medicine of Malaysia

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MANAGEMENT OF HIV INFECTION IN CHILDREN r) Immune Reconstitution Inflammatory Syndrome Case reports and retrospective cohort studies have established immune reconstitution inflammatory syndrome (also known as immune reconstitution disease or immune restoration disease), as a significant problem among patients initiated on HAART. This condition is characterized by a paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating ART and results from restored immunity to specific infectious or non-infectious antigens. There is no generally accepted case definition due to diverse and still expanding clinical spectrum of this condition. Proposed definition of IRIS includes the following: 35 208, Level 8 Receiving HAART • Decrease in HIV-1 RNA level from baseline • Increase in CD4+ cells from baseline (may lag HIV RNA decrease) Clinical symptoms consistent with inflammatory process Clinical course not consistent with: • Expected course of previously diagnosed OI • Expected course of newly diagnosed OI • Drug toxicity
Infectious etiologies • Mycobacterium tuberculosis • Mycobacterium avium complex • Other mycobacteria • Cytomegalovirus • Herpes viruses • Herpes zoster virus • Herpes simplex virus • Herpes virus-associated Kaposi's sarcoma • Cryptococcus neoformans • Pneumocystis jirovecii pneumonia (PCP) • Histoplasmosis capsulatum • Toxoplasmosis • Hepatitis B virus • Hepatitis C virus • Progressive multifocal leukoencephalitis • Parvovirus B19 • Strongyloides stercoralis infection & other parasitic infections • Molluscum contagiosum & genital warts • Sinusitis • Folliculitis MANAGEMENT OF HIV INFECTION IN CHILDREN Possible infectious and non-infectious aetiologies of IRIS are summarized 209, Level 9 below: 36 Non-infectious etiologies • Rheumatoid arthritis / Autoimmune • Systemic lupus erythematosus (SLE) • Graves disease, Autoimmune thyroid disease • Sarcoidosis & granulomatous reactions • Tattoo ink • AIDS-related lymphoma • Guillain-Barre' syndrome (GBS) • Interstitial lymphoid pneumonitis
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3.30 MB - Academy of Medicine of Malaysia

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