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Immune Reconstitution Inflammatory Syndrome and Paradoxical Reaction

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Book cover Current Trends and Concerns in Infectious Diseases

Part of the book series: Emerging Infectious Diseases of the 21st Century ((EIDC))

Abstract

The immune reconstitution inflammatory syndrome [IRIS] is a paradoxical worsening or unmasking of infection or neoplasm in HIV-infected patients shortly after institution of highly effective antiretroviral therapy [ART]. This syndrome was described over 20 years ago but the definition has now been extended to include worsening or unmasking of infections after the withdrawal of immunosuppressive agents from other conditions, such as in solid organ transplantation or in autoimmune diseases being treated with novel biologics. The medical literature has been replete with articles on this topic over the past 15 years or more, and investigators have been using the term IRIS even for natural infections with paradoxical reaction or worsening without previous immunosuppression or HIV infection. This chapter provides a classification to distinguish three distinct entities: HIV-IRIS, immunosuppressive-IRIS, and paradoxical reaction syndrome [PRS] for conditions without prior immunosuppression. Various subtypes are also present depending on the underlying infection or neoplasm worsening or unmasked, for example, tuberculosis [TB]-associated disease can be labeled as HIV-TB-IRIS. The clinical manifestations, frequency, immunopathogenesis, treatment, and prognosis are discussed.

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    I. W. Fong

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Fong, I.W. (2020). Immune Reconstitution Inflammatory Syndrome and Paradoxical Reaction. In: Current Trends and Concerns in Infectious Diseases. Emerging Infectious Diseases of the 21st Century. Springer, Cham. https://doi.org/10.1007/978-3-030-36966-8_2

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