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Charles Gomersall
First posted November 2006
Immune reconstitution syndrome
- associated with initiation of antiretroviral therapy in patients with
opportunitistic disease
- usually occurs within first few weeks after initiation but may occur
several months later
- most commonly described in patients with TB but has also been associated
with:
- Mycobacterium avium complex
- Pneumocystis jiroveci pneumonia (PCP)
- toxoplasmosis
- hepatitis B and C virus infection
- cytomegalovirus infection
- varcella-zoster virus infection
- cryptococcal infection
- characterized by:
- fever
- worsening of clinical features of opportunistic infection
- new manifestations of opportunistic infection
- features in patients with TB have included high fevers, worsening
lymphadenopathy, worsening of pulmonary infiltrates and expanding CNS
lesions
- management:
- exclude recrudescence of underlying opportunistic infection, new
infection or new drug toxicity first
- non-steroidal anti-inflammatory drugss or corticosteroids after
excluding the above
- inflammatory response may take weeks-months to subside
Further reading
Treating Opportunistic Infections among
HIV-Infected Adults and Adolescents:
Recommendations from CDC, the
National Institutes of Health,
and the HIV Medicine
Association/Infectious Diseases Society of
America
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