[Management of immune reconstitution inflammatory syndrome]

While antiretroviral therapy(ART) in HIV-infected patients results in dramatic reductions in HIV viral load and subsequent improvements in CD4 cell count, part of patients experience clinical deterioration as a direct consequence of rapid and dysregulated restoration of antigen-specific immune responses. This is termed "immune reconstitution inflammatory syndrome (IRIS)." Because there is no single agreed upon definition for IRIS, the diagnosis of IRIS is clinical. Several studies have demonstrated that lower CD4 cell count and higher viral load at the initiation of ART increase the risk of developing IRIS. Management of IRIS consists of appropriate treatment for the diseases of IRIS, control of the excessive inflammation (NSAIDs or corticosteroids), and interrupting ART.