[Immune reconstitution inflammatory syndrome in human immunodeficiency (HIV) infected patients]

Combination antiretroviral therapy (HAART) restores protective immune response and reduces morbidity and mortality in human immunodeficiency virus (HIV) infected patients, however this life-long therapy withholds many complications. In a subset of patients' immune reconstitution, after initiation of therapy, it is associated with a pathological inflammatory response leading to a paradoxical short term morbidity and even mortality, defined as the immune reconstitution inflammatory syndrome (IRIS). IRIS presents as clinical deterioration caused by restoration of the capacity to mount an inflammatory response against infectious and non-infections antigens. The inflammatory response can result in a spectrum of presentations ranging from mimicking acute infection to worsening of a treated opportunistic infection, malignant diseases or even an autoimmune disease. The mechanisms of IRIS remains to be evaluated, however in many cases redistribution of memory T cells can be demonstrated. Currently there are no laboratory tests or accepted criteria for the diagnosis of IRIS, which remains a diagnosis of exclusion. Recently, numerous groups have published studies regarding incidence, timing of onset, risk factors and therapy options for IRIS. This large resource of evidence may enable physicians to diagnose and treat patients more accurately. A consistent finding from different studies is that IRIS develops in a substantial percentage of HIV-infected patients receiving HAART. As the use of HAART increases worldwide, the care for patients receiving HAART will need to incorporate monitoring for and treating complications of IRIS.