Abstract

Dagnachew Muluye*, Desalegn Woldeyohannes, Mucheye Gizachew, Beyene Moges, Gizachew Yismaw, Moges Tirneh and Afework Kassu

Immune reconstitution inflammatory syndrome (IRIS) is a clinical syndrome that has been described in human immunodeficiency virus (HIV) infected patients after initiation of highly active anti-retroviral therapy. The immunopathogenesis of IRIS is characterized by a dysbalanced restoration of the immune system or by paradoxical acute worsening of an underlying opportunistic infection (OI) or acquired immune deficiency syndrome (AIDS)-defining illness. The incidence of IRIS varies in different conditions and depends on the patient population, being higher in patients with greater burden of infection and advanced disease. The risk factors were found to be low baseline CD4-cell count, an excellent virological response, an increased antigenic burden of an opportunistic infection and early initiation of antiretroviral treatment after an OI. The clinical effect of IRIS ranges from mild, self-limiting illness to severe morbidity and mortality. Diagnosis is difficult because of a diverse range of clinical presentations. Treatment dilemma is also a big issue which includes discontinuation of antiretroviral treatment, corticosteroids or pathogen-specific therapy. Early screening of patients is needed to rule out any OIs before the start of highly active anti-retroviral therapy. The lack of appropriate treatment guidelines poses challenges in the management of these patients, hence provision of treatment guidelines and engaging in more research regarding immunopathogenesis, diagnosis and treatment of IRIS should be well thought-out.