Immune reconstitution diseases: is it possible to establish recommendations?

The introduction of combination antiretroviral therapy (cART) has attracted the attention of scientists and physicians all over the world to the phenomenon known as IRD, immune restoration disease. The management of IRD depends on the correct diagnosis of the syndrome, which can be difficult to establish. The atypical presentation and unpredictable course of the disease may require individual decisions regarding a delay of cART or its interruption as well as the use of corticosteroids. Thus the frequent need for individualized management of IRD can make it difficult to obtain enough results from prospective randomized trials to establish strict recommendations. However, they should be initiated as soon as possible.