Immunopathogenesis, treatment and prevention of immune reconstitution inflammatory syndrome (IRIS)

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is a clinical syndrome that has been described in 
human immunodeficiency virus (HIV) infected patients after initiation of highly active anti-retroviral 
therapy. The immunopathogenesis of IRIS is characterized by a dysbalanced restoration of the immune 
system or by paradoxical acute worsening of an underlying opportunistic infection (OI) or acquired 
immune deficiency syndrome (AIDS)-defining illness. The incidence of IRIS varies in different 
conditions and depends on the patient population, being higher in patients with greater burden of 
infection and advanced disease. The risk factors were found to be low baseline CD4-cell count, an 
excellent virological response, an increased antigenic burden of an opportunistic infection and early 
initiation of antiretroviral treatment after an OI. The clinical effect of IRIS ranges from mild, self-limiting 
illness to severe morbidity and mortality. Diagnosis is difficult because of a diverse range of clinical 
presentations. Treatment dilemma is also a big issue which includes discontinuation of antiretroviral 
treatment, corticosteroids or pathogen-specific therapy. Early screening of patients is needed to rule 
out any OIs before the start of highly active anti-retroviral therapy. The lack of appropriate treatment 
guidelines poses challenges in the management of these patients, hence provision of treatment 
guidelines and engaging in more research regarding immunopathogenesis, diagnosis and treatment of 
IRIS should be well thought-out.