Immune Reconstitution Inflammatory Syndrome
Some patients starting ART develop new or worsening opportunistic infections or malignancies despite improvements in the clinical markers of HIV infection. These examples of paradoxical clinical worsening, known as immune reconstitution inflammatory syndrome (IRIS), occur in patients with previous opportunistic infections or low CD4+ T-lymphocyte levels. IRIS results from an inflammatory response to reemergence of the immune system's ability to recognize pathogens or from tumor antigens that were previously present but asymptomatic. With the increased availability of ART, more cases and more new forms of IRIS are likely to be recognized. Immune recovery uveitis (IRU) occurs in nearly 10% of HIV-infected patients with immune recovery and a history of CMV retinitis. Of these IRU patients, 46% develop significant cystoid macular edema and 49% develop epiretinal membrane.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.