Lawn Stephen D, Bekker Linda-Gail, Miller Robert F
Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Lancet Infect Dis. 2005 Jun;5(6):361-73. doi: 10.1016/S1473-3099(05)70140-7.
Immune reconstitution disease (IRD) in HIV-infected patients is an adverse consequence of the restoration of pathogen-specific immune responses during the initial months of highly active antiretroviral treatment (HAART). Previously subclinical infections are "unmasked" or pre-existing opportunistic infections clinically deteriorate as host immunopathological inflammatory responses are "switched on". IRD is most frequently associated with mycobacterial infections. Our literature search identified 166 published cases of IRD associated with mycobacterial infections. We review the underlying immunological mechanisms, difficulties surrounding case definition and diagnosis, the wide diversity of clinical manifestations, and treatment. The importance of screening patients for mycobacterial disease before starting HAART and the critical impact of the timing of commencement of HAART in patients receiving treatment for tuberculosis are highlighted. We also discuss the problem of IRD associated with mycobacterial diseases in developing countries where tuberculosis prevalence is high and access to HAART is currently expanding.
免疫重建疾病（IRD）在HIV感染患者中是高效抗逆转录病毒治疗（HAART）最初几个月期间病原体特异性免疫反应恢复的不良后果。先前的亚临床感染被“暴露”，或者随着宿主免疫病理炎症反应被“开启”，既往存在的机会性感染在临床上恶化。IRD最常与分枝杆菌感染相关。我们的文献检索确定了166例与分枝杆菌感染相关的IRD已发表病例。我们回顾了潜在的免疫机制、病例定义和诊断方面的困难、临床表现的广泛多样性以及治疗方法。强调了在开始HAART之前对患者进行分枝杆菌疾病筛查的重要性以及HAART开始时间对接受结核病治疗患者的关键影响。我们还讨论了在结核病患病率高且目前HAART可及性正在扩大的发展中国家与分枝杆菌疾病相关的IRD问题。
