Immune reconstitution inflammatory syndrome: the trouble with immunity when you had none.

Barber, Daniel L.; Andrade, Bruno B.; Sereti, Irini; Sher, Alan

Some individuals who are infected with HIV rapidly deteriorate shortly after starting antiretroviral therapy, despite effective viral suppression. This reaction, referred to as immune reconstitution inflammatory syndrome (IRIS), is characterized by tissue-destructive inflammation and arises as CD4 T cells re-emerge. It has been proposed that IRIS is caused by a dysregulation of the expanding population of CD4 T cells specific for a co-infecting opportunistic pathogen. Here, we argue that IRIS instead results from hyper-responsiveness of the innate immune system to T cell help, a mechanism that may be shared by the many manifestations of IRIS that occur following the reversal of other types of immunosuppression in pathogen-infected hosts.

IMMUNE reconstitution inflammatory syndrome; IMMUNITY; HIV infections; HIGHLY active antiretroviral therapy; IMMUNE system; T cells; PHYSIOLOGY

Nature Reviews Microbiology, 2012, Vol 10, Issue 2, p150

1740-1526

Academic Journal

10.1038/nrmicro2712