An IRIS is an undesirable outcome of restoring immune responses against an active (sometimes unrecognised) HIV-related infection or antigens of non-viable pathogens remaining after treatment of the infection (7). The strongest risk factors for an IRIS are a low CD4+ T cell count (usually <50/mL) and a high pathogen load (3, 7, 13) The latter is a …
An IRIS mostly occurs between 2 weeks and 3 months after ART commencement or ART intensification but may occur earlier (within days) and as late as a year after treatment. Temporal onset of an IRIS is particularly difficult to attribute in patients with erratic ART adherence. Typically, IRIS patients had a very low CD4+ T cell count …
For patients with a suspected paradoxical IRIS, the initial consideration is exclusion of a recurrence of the associated infection or development of a new infection. For example, when suspecting paradoxical TB-IRIS, considerations should include non-adherence to TB medications, infection with drug-resistant mycobacteria, new community-acquired pneumonia, PJP and viral infections. Investigations should include sputum microscopy and …
Given that severe CD4+ T cell deficiency when ART is commenced is a risk factor for an IRIS, prevention of CD4+ T cell depletion through early diagnosis and treatment of HIV infection regardless of CD4+ T cell count, as supported by the findings of the START study (33), is the most effective measure for reducing the risk …
Autoimmune diseases and immune-mediated inflammatory diseases may also be encountered in patients receiving ART (49) and many appear to be immune reconstitution disorders. Pathogenic mechanisms, however, are distinct from those in an IRIS associated with HIV-related infections or cancers. Psoriasis, sarcoidosis, rheumatoid arthritis, ankylosing spondyloarthritis, Graves’ disease, autoimmune hemolytic anemia, immune thrombocytopenia and inflammatory bowel disease are most common …
Autoimmune disease and immune-mediated inflammatory disease in patients receiving ART Read More »
French MA, Mallal SA, Dawkins RL. Zidovudine-induced restoration of cell-mediated immunity to mycobacteria in immunodeficient HIV-infected patients. AIDS 1992; 6:1293-7. French MA, Lenzo N, John M et al. Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy. HIV Med 2000; 1:107-15. French MA. Immune reconstitution inflammatory syndrome: immune restoration …
Rohan Bopage1, Deborah Couldwell1, Mark Boyd2 Western Sydney Sexual Health Centre, Sydney, New South Wales University of Adelaide, Adelaide, South Australia Last reviewed: June 2021 Introduction Long term management of HIV infection encompasses the following broad objectives: Prevention of HIV disease progression and associated mortality and morbidity; Restoration and preservation of immunologic function; Prevention of …
The main objective of monitoring PWH receiving ART is to optimise the efficacy of ART while minimising ART-related adverse drug reactions and toxicities. HIV RNA (viral load) and CD4+ T cell (CD4) count are the two surrogate markers of ART response and HIV disease progression. In addition to the CD4 count and viral load, a …
The goal of ART is to suppress HIV replication to a level below which drug-resistance mutations do not emerge within the HIV genome. Although not conclusive, most evidence suggests that selection of drug-resistance mutations does not occur in patients with plasma HIV RNA levels persistently suppressed to below 200 copies/mL, although virological suppression to below …
The possibility of antiretroviral drug resistance should be considered before commencing any antiretroviral drug regimen, whether initial treatment or subsequent changes in regimen, and if virological suppression is sub-optimal. When a person is newly infected with HIV, he or she may be infected with a strain that already carries drug-resistance mutations; this is known as …
Principles of managing antiretroviral drug resistance Read More »
Developing a sustainable HIV, Viral Hepatitis and Sexual Health Workforce
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