IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME IN HIV INFECTION

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Abstract

Antiretroviral therapy (ART) leads to suppression of HIV replication, contributes to increase in the number of CD4-lymphocytes count and  partial restoration or activation of the immune system. The  consequence is a reduction of incidence of opportunistic diseases,  increase in the duration and quality of life of people living with HIV  (PLHIV). However, in some patients with severe immunosuppression, this may be accompanied by a worsening of the condition and risks  of formation of the immune reconstitution inflammatory syndrome  (IRIS), which manifests itself in the development of new or  previously treated opportunistic, secondary and exacerbating non- infectious diseases against a virologically effective ART. The  frequency of the development of IRIS varies widely, in cases of  tuberculosis-associated manifestation it can reach 50%. Risk factors  for the development of IRIS are low initial CD4-lymphocyte count  and a high load of HIV RNA in the blood, the presence of  opportunistic infections during the initiation of ART. Discussed terminology issues, other possible risk factors for the  development of the syndrome, regularities of the pathological process are considered. Epidemiological statistics of  IRIS, pathogenetic bases, variants of clinical and laboratory  manifestations of complications are given. The criteria for diagnosis  of the syndrome, as well as the necessary conditions for its  occurrence, are considered. Particular attention is paid to the most  common opportunistic infections that cause the manifestation of  IRIS, the peculiarities and polymorphism of clinical manifestations  and the prevention of their occurrence. Currently, there is an  increasing incidence of HIV infection in the late stages. Laboratory  and clinical differences in the manifestations of acquired  immunodeficiency syndrome (AIDS) and IRIS have been sanctified. In view of the blurring of the diagnostic criteria, in the  Russian Federation specialists rarely expose IRIS to clinical or pathological diagnoses, therefore it is rather difficult to trace the  frequency of occurrence of this condition. Clinical and laboratory  manifestations are systematized, which allows to formulate this  diagnosis on the basis of their totality. Prevention of IRIS is the  prudent prescription of antiretroviral drugs. It is neces sary to  conduct a qualitative and timely diagnosis of concomitant diseases of infectious and non-infectious nature before the initiation of ART and  during treatment, the appointment of effective etiotropic therapy for  opportunistic and secon dary infections. In order to improve the  prognosis of HIV infection, preferably early onset of ART with stable  CD4-lym phocyte counts and low HIV RNA levels in the blood.

About the authors

E. V. Boeva

Pavlov First State Medical University

St. Petersburg Paster Institute

Author for correspondence.
Email: kathrine.boeva@gmail.com

Resident of the Department of Socially Significant Infections, First Pavlov State Medical University,  St. Petersburg, Russian Federation; Infectious Disease  Doctor, Head of Department of Chronic Viral Infection in  North-West District Center for Prevention and Control of  AIDS, St. Petersburg Pasteur Institute, St. Petersburg, Russian Federation

197101, Russian Federation, St. Petersburg, Mira str., 14

Phone: +7 911 792-91-94

Russian Federation

N. A. Belyakov

Pavlov First State Medical University

St. Petersburg Paster Institute

Email: fake@neicon.ru

PhD, MD (Medicine), Professor, RAS Full Member, Head of  the Department of Socially Significant Infections, First Pavlov State Medical University, St. Petersburg,  Russian Federation; Chief Researcher of the Institute of  Experimental Medicine, St. Petersburg, Russian Federation;  Head of North-West District Center for Prevention and  Control of AIDS, St. Petersburg Pasteur Institute, St. Petersburg, Russian Federation

Russian Federation

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