Immune reconstitution inflammatory syndrome

Immune reconstitution inflammatory syndrome has been described as a syndrome attributed to immune reconstitution occasionally observed following initiation of HAART. During the first 8 to 12 weeks following suppression of HIV replication with HAART, there is a rapid influx of memory T cells that have been trapped within inflamed lymphatic tissues and a slow recovery of naive T cells that seem to derive from both redistribution from the periphery and new thymic production [128,129]. Functional studies demonstrate that despite normalization of CD4 cell numbers, HIV-specific immunity and complete immune restoration seldom occurs. Despite this limitation, post-HAART immune reconstitution inflammatory syndrome seems capable of providing protection from opportunistic infections, although the restoration of immunity can also have adverse consequences. An inflammatory reaction following institution of HAART has been described and is believed to result from an augmented immune response to pathogens that are prevalent in the host but have been clinically occult. It has been showed by numerous reports of immune reconstitution inflammatory syndrome in response to intracellular pathogens (Mycobacterium avium-intracellulare [MAI] complex, Mycobacterium tuberculosis, Histoplasma capsulatum, cytomegalovirus, hepatitis B and C) [130-134]. The mean onset to immune reconstitution inflammatory syndrome appearance following HAART was up to 9 months and most resolved with little or no therapy. Although immune reconstitution inflammatory syndrome is best understood when it occurs in response to a microbial pathogen, it should not be surprising that a similar response manifesting as either the de novo appearance or exacerbation of a previously quiescent or occult neoplasia, such as Kaposi's sarcoma [135], or an autoimmune syndrome (RA [136], SLE [137,138], Reiter's syndrome [RS] [139]) may also occur. Additionally in this context, less than 50 cases have been individually described with sarcoidosis and autoimmune thyroid disease being most common with arthritis and various forms of connective tissue disease making up the rest [133].

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