Sanghi S, Grewal R S, Vasudevan B, Lodha N
Department of Dermatology, Command Hospital, Wanowrie, Pune-411040, India.
Indian J Lepr. 2011 Apr-Jun;83(2):61-70.
Immune reconstitution inflammatory syndrome (IRIS) is a paradoxical deterioration in the clinical status of a patient infected with human immunodeficiency virus (HIV) on highly active antiretroviral treatment (HAART). The immune suppression caused by the virus can initially suppress the clinical manifestations of leprosy which can then be unmasked after treatment with HAART or an inflammatory reaction can occur in the initial months of therapy, resulting from dysregulated recovery of immunity to specific antigens. Both these conditions are identified as IRIS in leprosy. Though this syndrome is a widely recognized entity presently, there is still a lack of universally acceptable diagnostic criteria for the condition. The first case published case of leprosy- associated immune reconstitution disease was reported in 2003 and about 47 confirmed cases of IRIS in leprosy have been reported since then, mostly from Brazil and India. Anti-inflammatory drugs and steroids are the drugs of choice in inflammatory episodes with continuation of antiretroviral therapy. With increasing affordability of antiretroviral therapy, clinicians will put more and more number of human immunodeficiency virus infected patients on therapy and hence an increase in the incidence of IRIS is expected. Therefore, it is important to understand all facets of this syndrome which is becoming more prevalent with each passing day.
免疫重建炎症综合征（IRIS）是指接受高效抗逆转录病毒治疗（HAART）的人类免疫缺陷病毒（HIV）感染者临床状况出现的矛盾性恶化。病毒引起的免疫抑制最初可抑制麻风的临床表现，在接受HAART治疗后这些表现可能会显现出来，或者在治疗的最初几个月可能会发生炎症反应，这是由于对特定抗原的免疫恢复失调所致。这两种情况在麻风病中均被认定为IRIS。尽管目前该综合征是一个广为人知的实体，但对于该病症仍缺乏普遍可接受的诊断标准。2003年报道了首例麻风相关免疫重建疾病病例，自那时以来，已报道了约47例确诊的麻风病IRIS病例，大多来自巴西和印度。在炎症发作时，抗炎药和类固醇是首选药物，同时继续进行抗逆转录病毒治疗。随着抗逆转录病毒治疗费用的可承受性增加，临床医生将使越来越多的人类免疫缺陷病毒感染患者接受治疗，因此预计IRIS的发病率将会上升。因此，了解这一日益普遍的综合征的各个方面非常重要。
