Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy


Lawn, SD; Meintjes, G; (2011) Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy. Expert review of anti-infective therapy, 9 (4). pp. 415-430. ISSN 1478-7210 DOI: https://doi.org/10.1586/eri.11.21

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Abstract

The risks of unmasking and paradoxical forms of immune reconstitution disease in HIV-infected patients starting antiretroviral therapy (ART) are fuelled by a combination of the late presentation of patients with advanced immunodeficiency, the associated high rates of opportunistic infections (Ols) and the need for rapid initiation of ART to minimize overall mortality risk. We review the risk factors and our current knowledge of the immunopathogenesis of immune reconstitution disease, leading to a discussion of strategies for prevention. Initiation of ART at higher CD4 counts, use of Ol-preventive therapies prior to ART eligibility, intensified screening for Ols prior to ART initiation and optimum therapy for Ols are all needed. In addition, use of a range of pharmacological agents with immunosuppressive and immunomodulatory activity is being explored.

Item Type: Article
Keywords: antiretroviral, HIV, immune reconstitution, immune reconstitution, inflammatory syndrome, IRIS, prevention, HIV-INFECTED PATIENTS, RESOURCE-LIMITED SETTINGS, PROGRESSIVE, MULTIFOCAL LEUKOENCEPHALOPATHY, SUB-SAHARAN AFRICA, ACQUIRED-IMMUNODEFICIENCY-SYNDROME, SERUM CRYPTOCOCCAL ANTIGEN, RIO-DE-JANEIRO, INFLAMMATORY SYNDROME, SOUTH-AFRICA, RESTORATION DISEASE
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 21504399
Web of Science ID: 290839700013
URI: http://researchonline.lshtm.ac.uk/id/eprint/663

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