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Immune reconstitution

Up Immune reconstitution Penicillium marneffei

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

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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