Review

Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options

David M Murdoch^1,3,5 , Willem DF Venter² , Annelies Van Rie³ and Charles Feldman⁴

¹  Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham North Carolina, USA

²  Reproductive Health & HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa

³  Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

⁴  Division of Pulmonology, Department of Medicine, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa

⁵  CB#7435, 2104-H McGavran-Greenberg Hall, University of North Carolina, School of Public Health, Chapel Hill, NC 27599-7435, USA

author email corresponding author email

AIDS Research and Therapy 2007, 4:9doi:10.1186/1742-6405-4-9

Published:	8 May 2007

Abstract

The immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients initiating antiretroviral therapy (ART) results from restored immunity to specific infectious or non-infectious antigens. A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating therapy characterizes the syndrome. Potential mechanisms for the syndrome include a partial recovery of the immune system or exuberant host immunological responses to antigenic stimuli. The overall incidence of IRIS is unknown, but is dependent on the population studied and its underlying opportunistic infectious burden. The infectious pathogens most frequently implicated in the syndrome are mycobacteria, varicella zoster, herpesviruses, and cytomegalovirus (CMV). No single treatment option exists and depends on the underlying infectious agent and its clinical presentation. Prospective cohort studies addressing the optimal screening and treatment of opportunistic infections in patients eligible for ART are currently being conducted. These studies will provide evidence for the development of treatment guidelines in order to reduce the burden of IRIS. We review the available literature on the pathogenesis and epidemiology of IRIS, and present treatment options for the more common infectious manifestations of this diverse syndrome and for manifestations associated with a high morbidity.