Expert Review of Anti-infective Therapy Downloaded from informahealthcare.com by Nanyang Technological University on 04/26/15 For personal use only.
Review
Opportunistic infections and immune reconstitution inflammatory syndrome in HIV-1-infected adults in the combined antiretroviral therapy era: a comprehensive review Expert Rev. Anti Infect. Ther. Early online, 1–17 (2015)
Christian Manzardo*1, Alberto C Guardo1, Emilio Letang2,3, Montserrat Plana1, Jose M Gatell1 and Jose M Miro*1 1 Infectious Diseases Service and HIV Research Unit, Hospital Clinic – IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain 2 Swiss Tropical and Public Health Institute, Basel, Switzerland 3 ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clı´nic – Universitat de Barcelona, Barcelona, Spain *Authors for correspondence: [email protected]; [email protected]
informahealthcare.com
Despite the availability of effective combined antiretroviral treatment, many patients still present with advanced HIV infection, often accompanied by an AIDS-defining disease. A subgroup of patients starting antiretroviral treatment under these clinical conditions may experience paradoxical worsening of their disease as a result of an exaggerated immune response towards an active (but also subclinical) infectious agent, despite an appropriate virological and immunological response to the treatment. This clinical condition, known as immune reconstitution inflammatory syndrome, may cause significant morbidity and even mortality if it is not promptly recognized and treated. This review updates current knowledge about the incidence, diagnostic criteria, risk factors, clinical manifestations, and management of opportunistic infections and immune reconstitution inflammatory syndrome in the combined antiretroviral treatment era. KEYWORDS: AIDS-defining diseases . combined antiretroviral therapy . immune reconstitution inflammatory syndrome .
IRIS definition
.
IRIS incidence . IRIS management
.
IRIS treatment
Despite the fact that combined antiretroviral therapy (cART) leads to good control of HIV infection in individuals starting treatment with a CD4+ T-cell count above 200 cells/ml [1,2], delayed diagnosis of HIV infection can mean that some patients initiate cART with severe impairment of their immune system. Despite efforts to diagnose HIV infection earlier, a considerable proportion of patients still present late, with a CD4+ T-cell count
Review
Opportunistic infections and immune reconstitution inflammatory syndrome in HIV-1-infected adults in the combined antiretroviral therapy era: a comprehensive review Expert Rev. Anti Infect. Ther. Early online, 1–17 (2015)
Christian Manzardo*1, Alberto C Guardo1, Emilio Letang2,3, Montserrat Plana1, Jose M Gatell1 and Jose M Miro*1 1 Infectious Diseases Service and HIV Research Unit, Hospital Clinic – IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain 2 Swiss Tropical and Public Health Institute, Basel, Switzerland 3 ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clı´nic – Universitat de Barcelona, Barcelona, Spain *Authors for correspondence: [email protected]; [email protected]
informahealthcare.com
Despite the availability of effective combined antiretroviral treatment, many patients still present with advanced HIV infection, often accompanied by an AIDS-defining disease. A subgroup of patients starting antiretroviral treatment under these clinical conditions may experience paradoxical worsening of their disease as a result of an exaggerated immune response towards an active (but also subclinical) infectious agent, despite an appropriate virological and immunological response to the treatment. This clinical condition, known as immune reconstitution inflammatory syndrome, may cause significant morbidity and even mortality if it is not promptly recognized and treated. This review updates current knowledge about the incidence, diagnostic criteria, risk factors, clinical manifestations, and management of opportunistic infections and immune reconstitution inflammatory syndrome in the combined antiretroviral treatment era. KEYWORDS: AIDS-defining diseases . combined antiretroviral therapy . immune reconstitution inflammatory syndrome .
IRIS definition
.
IRIS incidence . IRIS management
.
IRIS treatment
Despite the fact that combined antiretroviral therapy (cART) leads to good control of HIV infection in individuals starting treatment with a CD4+ T-cell count above 200 cells/ml [1,2], delayed diagnosis of HIV infection can mean that some patients initiate cART with severe impairment of their immune system. Despite efforts to diagnose HIV infection earlier, a considerable proportion of patients still present late, with a CD4+ T-cell count
