Management of the Immune Reconstitution Inflammatory Syndrome

被引：0
作者：
Graeme Meintjes
James Scriven
Suzaan Marais
机构：
[1] University of Cape Town,Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine
[2] University of Cape Town,Division of Infectious Diseases and HIV Medicine
[3] GF Jooste Hospital,Department of Medicine
[4] Imperial College London,Liverpool School of Tropical Medicine
[5] Liverpool University,Division of Neurology, Department of Medicine
[6] University of Cape Town,Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences
[7] University of Cape Town,undefined
来源：
Current HIV/AIDS Reports | 2012年 / 9卷
关键词：
HIV; AIDS; Antiretroviral therapy; Immune reconstitution inflammatory syndrome; Tuberculosis; Cryptococcosis; Mycobacterial disease; Cytomegalovirus; Kaposi’s sarcoma; Progressive multifocal leukoencephalopathy; Viral hepatitis; Corticosteroids;
D O I：
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中图分类号：
学科分类号：
摘要：
The immune reconstitution inflammatory syndrome (IRIS) is a frequent early complication of antiretroviral therapy (ART) in patients with advanced HIV. Because there is no confirmatory diagnostic test, the diagnosis is based on clinical presentation and exclusion of alternative causes for deterioration, such as antimicrobial drug resistance. Opportunistic infection treatment should be optimized. Mild cases may require symptomatic therapy alone or nonsteroidal anti-inflammatory drugs. Corticosteroids have been used to treat more severe cases of IRIS associated with mycobacterial and fungal infections. There is evidence from a randomized controlled trial that prednisone reduces morbidity and improves symptoms in paradoxical tuberculosis (TB)-IRIS. Neurological TB-IRIS is potentially life-threatening; high-dose corticosteroids are indicated and ART interruption should be considered if level of consciousness is depressed. When considering corticosteroid treatment clinicians should be aware of their side effects and only use them when the diagnosis of IRIS is certain. In viral forms of IRIS corticosteroids are generally avoided.
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页码：238 / 250
页数：12
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