Lawn Stephen D, French Martyn A
The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Curr Opin HIV AIDS. 2007 Jul;2(4):339-45. doi: 10.1097/COH.0b013e3281a3c0a6.
We review literature published over the past 2 years regarding the immunopathogenesis, epidemiology, clinical spectrum and outcomes of immune reconstitution disease in patients receiving antiretroviral treatment. Particular attention is drawn to data relevant to resource-limited settings.
In high-income countries, immune reconstitution disease occurs in association with a largely predictable spectrum of pathogens, including the herpesviruses, Mycobacterium tuberculosis and Mycobacterium avium complex, Cryptococcus neoformans and hepatitis viruses. Dermatological manifestations are most frequent. In resource-limited settings, patients accessing antiretroviral treatment programmes typically have advanced immunodeficiency, which increases risk of immune reconstitution disease. M. tuberculosis and C. neoformans have emerged as the key causes of morbidity and mortality associated with immune reconstitution disease. An increasing number of 'tropical' infections, including leprosy, schistosomiasis, strongyloidiasis, leishmaniasis, histoplasmosis and many nontuberculous mycobacteria, are also now recognised to provoke immune reconstitution disease but the overall spectrum and relative importance of these organisms remain to be defined. Better characterisation of immune reconstitution disease in these settings is needed to enable development of guidelines regarding prevention, diagnosis and management.
While immune reconstitution disease in high-income countries has been clinically and epidemiologically well described, much remains to be learned in resource-limited settings in which immune reconstitution disease is emerging as a significant cause of morbidity and mortality.
我们回顾过去两年发表的关于接受抗逆转录病毒治疗患者免疫重建疾病的免疫发病机制、流行病学、临床谱及转归的文献。特别关注与资源有限地区相关的数据。
在高收入国家，免疫重建疾病与一系列在很大程度上可预测的病原体有关，包括疱疹病毒、结核分枝杆菌和鸟分枝杆菌复合群、新型隐球菌及肝炎病毒。皮肤表现最为常见。在资源有限地区，接受抗逆转录病毒治疗项目的患者通常存在严重免疫缺陷，这增加了免疫重建疾病的风险。结核分枝杆菌和新型隐球菌已成为与免疫重建疾病相关的发病和死亡的主要原因。越来越多的“热带”感染，包括麻风病、血吸虫病、类圆线虫病、利什曼病、组织胞浆菌病及许多非结核分枝杆菌，现在也被认为可引发免疫重建疾病，但这些病原体的总体谱及相对重要性仍有待确定。需要更好地描述这些地区的免疫重建疾病，以制定关于预防、诊断和管理的指南。
虽然高收入国家的免疫重建疾病在临床和流行病学方面已有充分描述，但在资源有限地区仍有许多有待了解之处，在这些地区免疫重建疾病正成为发病和死亡的重要原因。
