Clinical Manual for Management of the HIV-Infected ... - myCME.com

Immune Reconstitution Syndrome
Background
For most patients, initiating antiretroviral therapy
(ART) improves immune responses to a wide range of
opportunistic pathogens. The process of ART-induced
immune reconstitution typically is uneventful. However,
a small percentage of patients develop inflammatory
disease in response to specific opportunistic pathogens
within a few weeks or months of initiating therapy.
This exuberant inflammatory response has been called
the immune reconstitution syndrome (IRS), and is also
known as immune reconstitution inflammatory syndrome
(IRIS) or immune reconstitution disease (IRD).
IRS may present as the following:
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An exacerbation of a partially or successfully treated
opportunistic infection (OI)
A previously undiagnosed (subclinical) OI
IRS may occur in response to many pathogens,
including Mycobacterium tuberculosis (TB),
Mycobacterium avium complex (MAC), cytomegalovirus
(CMV), Cryptococcus, Pneumocystis, Toxoplasma, hepatitis
B, and varicella zoster virus.
Many of the IRS cases reported in the literature have
occurred within a few months of initiating ART and
in the context of a rapid and marked rise in CD4
count from very low pretreatment levels (often