Walker Naomi F, Scriven James, Meintjes Graeme, Wilkinson Robert J
Department of Medicine, Imperial College London, London, UK ; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa ; Department of Medicine, University of Cape Town, Cape Town, South Africa.
Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa ; Department of Medicine, University of Cape Town, Cape Town, South Africa ; Liverpool School of Tropical Medicine, Liverpool, UK.
HIV AIDS (Auckl). 2015 Feb 12;7:49-64. doi: 10.2147/HIV.S42328. eCollection 2015.
Access to antiretroviral therapy (ART) is improving worldwide. Immune reconstitution inflammatory syndrome (IRIS) is a common complication of ART initiation. In this review, we provide an overview of clinical and epidemiological features of HIV-associated IRIS, current understanding of pathophysiological mechanisms, available therapy, and preventive strategies. The spectrum of HIV-associated IRIS is described, with a particular focus on three important pathogen-associated forms: tuberculosis-associated IRIS, cryptococcal IRIS, and Kaposi's sarcoma IRIS. While the clinical features and epidemiology are well described, there are major gaps in our understanding of pathophysiology and as a result therapeutic and preventative strategies are suboptimal. Timing of ART initiation is critical to reduce IRIS-associated morbidity. Improved understanding of the pathophysiology of IRIS will hopefully enable improved diagnostic modalities and better targeted treatments to be developed.
在全球范围内，抗逆转录病毒疗法（ART）的可及性正在提高。免疫重建炎症综合征（IRIS）是开始ART治疗时常见的并发症。在本综述中，我们概述了与HIV相关的IRIS的临床和流行病学特征、对病理生理机制的当前认识、可用的治疗方法以及预防策略。描述了与HIV相关的IRIS的范围，特别关注三种重要的病原体相关形式：结核相关IRIS、隐球菌性IRIS和卡波西肉瘤IRIS。虽然临床特征和流行病学已有充分描述，但我们对病理生理学的理解仍存在重大差距，因此治疗和预防策略并不理想。开始ART治疗的时机对于降低与IRIS相关的发病率至关重要。对IRIS病理生理学的更好理解有望促成更好的诊断方法和更有针对性的治疗方法的开发。
