Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
Eur J Clin Microbiol Infect Dis. 2012 Jun;31(6):919-27. doi: 10.1007/s10096-011-1413-9. Epub 2011 Oct 2.
The immune reconstitution inflammatory syndrome (IRIS) is a consequence of an excessive pathogen-specific immune recovery reaction and occurs in a subset of patients on antiretroviral therapy (ART). Infective forms of IRIS may present either as an 'unmasking' of a previously subclinical infection or the paradoxical clinical deterioration of an infection for which the patient received appropriate antimicrobial therapy. The most important risk factors for IRIS are a low CD4+ T-cell count and a short time between treatment of the infection and the commencement of ART. The general approach to the treatment of IRIS is to continue ART and provide antimicrobial therapy for the provoking infection. The majority of cases are self-limiting; however, mortality and hospitalisation rates are particularly high when tuberculosis- or cryptococcal-IRIS affects the central nervous system (CNS). Corticosteroid therapy should be considered in certain forms of IRIS after the exclusion of other conditions that could explain the inflammatory manifestations in the patients. Given that a low CD4+ T-cell count is a major risk factor for the development of IRIS, commencing ART at a CD4+ T-cell count of >350/μL will prevent most cases.
免疫重建炎症综合征（IRIS）是一种过度的病原体特异性免疫恢复反应的结果，发生在接受抗逆转录病毒治疗（ART）的患者亚组中。IRIS 的感染形式可能表现为先前亚临床感染的“暴露”，或者是患者接受适当抗菌治疗的感染的矛盾临床恶化。IRIS 的最重要危险因素是 CD4+ T 细胞计数低和治疗感染与开始 ART 之间的时间短。IRIS 的一般治疗方法是继续 ART 并为引起感染提供抗菌治疗。大多数病例是自限性的；然而，当结核或隐球菌性 IRIS 影响中枢神经系统（CNS）时，死亡率和住院率特别高。在排除可能解释患者炎症表现的其他情况后，应考虑在某些形式的 IRIS 中使用皮质类固醇治疗。鉴于 CD4+ T 细胞计数低是 IRIS 发展的主要危险因素，在 CD4+ T 细胞计数 >350/μL 时开始 ART 将预防大多数病例。
