Manzardo Christian, Guardo Alberto C, Letang Emilio, Plana Montserrat, Gatell Jose M, Miro Jose M
Infectious Diseases Service and HIV Research Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
Expert Rev Anti Infect Ther. 2015 Jun;13(6):751-67. doi: 10.1586/14787210.2015.1029917. Epub 2015 Apr 10.
Despite the availability of effective combined antiretroviral treatment, many patients still present with advanced HIV infection, often accompanied by an AIDS-defining disease. A subgroup of patients starting antiretroviral treatment under these clinical conditions may experience paradoxical worsening of their disease as a result of an exaggerated immune response towards an active (but also subclinical) infectious agent, despite an appropriate virological and immunological response to the treatment. This clinical condition, known as immune reconstitution inflammatory syndrome, may cause significant morbidity and even mortality if it is not promptly recognized and treated. This review updates current knowledge about the incidence, diagnostic criteria, risk factors, clinical manifestations, and management of opportunistic infections and immune reconstitution inflammatory syndrome in the combined antiretroviral treatment era.
尽管有有效的联合抗逆转录病毒治疗方法，但仍有许多患者出现晚期HIV感染，常伴有艾滋病定义疾病。在这些临床情况下开始接受抗逆转录病毒治疗的一部分患者，可能会因对活跃（但也为亚临床）感染因子的免疫反应过度，尽管对治疗有适当的病毒学和免疫学反应，但其病情仍会出现矛盾性恶化。这种临床状况称为免疫重建炎症综合征，如果不及时识别和治疗，可能会导致严重发病甚至死亡。本综述更新了关于联合抗逆转录病毒治疗时代机会性感染和免疫重建炎症综合征的发病率、诊断标准、危险因素、临床表现及管理的当前知识。
