Division of Pulmonology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
Curr Opin Pulm Med. 2011 May;17(3):180-8. doi: 10.1097/MCP.0b013e328344f692.
Immune reconstitution inflammatory syndrome (IRIS) is a common occurrence in HIV patients starting antiretroviral therapy (ART), and pulmonary involvement is an important feature of tuberculosis-IRIS and pneumocystis-IRIS. Pulmonologists need an awareness of the timing, presentation and treatment of pulmonary IRIS.
Case definitions for tuberculosis-IRIS and cryptococcal-IRIS have been published by the International Network for the Study of HIV-associated IRIS (INSHI). A number of studies have addressed validation of clinical case definitions and the optimal time to commence ART after diagnosis of an opportunistic infection in HIV patients. The pathogenesis of IRIS is being assessed at a molecular level, increasing our understanding of mechanisms and possible targets for future preventive and therapeutic strategies.
Tuberculosis-IRIS, nontuberculosis mycobacterial-IRIS and pneumocystis-IRIS occur within days to weeks of starting ART, causing substantial morbidity, but low mortality. Cryptococcal-IRIS usually occurs later in the course of ART, and may be associated with appreciable mortality. Early recognition of unmasking and paradoxical IRIS affecting the lung allows timely initiation of antimicrobial and/or immunomodulatory therapies.
免疫重建炎症综合征（IRIS）是开始抗逆转录病毒治疗（ART）的 HIV 患者的常见现象，肺部受累是结核病-IRIS 和肺孢子菌-IRIS 的重要特征。肺病学家需要了解肺部 IRIS 的发生时间、表现和治疗。
国际 HIV 相关 IRIS 研究网络（INSHI）已经发布了结核病-IRIS 和隐球菌-IRIS 的病例定义。许多研究都针对机会性感染后开始 ART 的最佳时机和临床病例定义的验证进行了探讨。IRIS 的发病机制正在分子水平上进行评估，这增加了我们对机制的理解，并为未来的预防和治疗策略提供了可能的靶点。
开始 ART 后数天至数周内会发生结核病-IRIS、非结核分枝杆菌-IRIS 和肺孢子菌-IRIS，导致严重的发病率，但死亡率较低。隐球菌-IRIS 通常在 ART 治疗过程中较晚发生，并且可能与相当高的死亡率相关。早期识别影响肺部的脱抑制和矛盾性 IRIS 可及时开始抗菌和/或免疫调节治疗。
