Immune reconstitution inflammatory syndrome: more answers, more questions

Abstract

The development of highly active antiretroviral therapy (HAART) has markedly improved the outlook for patients infected with HIV.¹ While the receipt of HAART engenders protective immune responses against a wide variety of pathogens, for some patients a profound, pathological inflammatory reaction ensues targeted at either subclinical or previously recognized microbes.^2–4 The inflammatory response can result in a spectrum of presentations ranging from clinical worsening of a treated opportunistic infection (OI), atypical appearance of an unrecognized OI to even autoimmune disorders such as Graves' disease.^5–7 A multitude of names have been applied to these situations including immune restoration disease and immune reconstitution inflammatory syndrome (IRIS).^2–5