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Is acute appendicitis another inflammatory condition associated with highly active antiretroviral therapy (HAART)?
T Aldeen1, M Horgan, D C Macallan
1Department of Genitourinary Medicine, St George's Hospital, London, UK.
HIV Medicine
|December 12, 2001
Summary
Acute appendicitis may signal immune reconstitution inflammatory syndrome (IRIS) in HIV patients starting highly active antiretroviral therapy (HAART). This finding suggests a potential new manifestation of IRIS in immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Immunology
- Gastroenterology
Background:
- Highly active antiretroviral therapy (HAART) has transformed HIV management, leading to immune reconstitution.
- Immune Restoration Inflammatory Syndrome (IRIS) is a known complication characterized by paradoxical inflammatory responses.
- The spectrum of IRIS manifestations continues to expand as more patients initiate HAART.
Observation:
- This study reports on four cases of acute appendicitis in HIV-positive patients within six months of commencing or altering HAART.
- The patients were undergoing treatment for HIV and presented with symptoms consistent with appendicitis.
- Clinical data, including HIV markers, HAART regimens, and abdominal ultrasound findings, were reviewed.
Findings:
- Acute appendicitis was observed in four out of approximately 350 HIV patients on HAART.
- The onset of appendicitis occurred within a critical window of 6 months after initiating or changing HAART.
- Histopathological examination of appendiceal tissue was performed in two cases, providing further diagnostic detail.
Implications:
- Acute appendicitis may represent an atypical presentation of IRIS in the context of HIV and HAART.
- This potential link warrants further investigation into the immunopathological mechanisms involved.
- Clinicians should consider IRIS when HIV patients on HAART present with acute abdominal symptoms like appendicitis.