Journal
EXPERT REVIEW OF ANTI-INFECTIVE THERAPY
Volume 9, Issue 4, Pages 415-430Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1586/ERI.11.21
Keywords
antiretroviral; HIV; immune reconstitution; immune reconstitution inflammatory syndrome; IRIS; prevention
Funding
- Wellcome Trust, London, UK
- Fogarty International Center
- NIH [NIH/FIC U2RTW007373-01A1, U2RTW007370-01A1]
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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.
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