Immune reconstitution inflammatory syndrome: immunopathogenesis, risk factors, diagnosis, treatment and prevention

Immune reconstitution inflammatory syndrome (IRIS) occurs in a subpopulation of HIV-infected patients after the introduction of antiretroviral therapy (ART). The purpose of this review is to describe the immunopathogenesis, risk factors, diagnostic problems, treatment and prevention of IRIS. A literature search was performed and finally 15 recent articles were selected. The immunopathogenesis of IRIS is characterised by a dysbalanced restoration of the immune system resulting in pathological inflammation. Risk factors are low baseline CD4-cell count, an excellent virological response, an increased antigenic burden of an opportunistic infection and early initiation of ART after an opportunistic infection. The differential diagnosis of IRIS is elaborate. Treatment options include discontinuation of ART, corticosteroids or pathogen-specific therapy. Diagnosis can be difficult, because IRIS may manifest with a diverse range of clinical presentations. Adopting one case definition and performing more research regarding diagnosis and treatment of IRIS are important recommendations for future studies.