Management of patients with the immune reconstitution inflammatory syndrome

被引：47

作者：

Meintjes G. ^{[1
]}

Marais S. ^{[1
]}

Wilkinson R.J. ^{[1
]}

Pepper D.J. ^{[1
]}

机构：

[1] Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Anzio Road

来源：

Current HIV/AIDS Reports | 2009年 / 6卷 / 3期

基金：

英国医学研究理事会;

关键词：

Thalidomide; Montelukast; Immune Reconstitution; Cryptococcal Meningitis; Progressive Multifocal Leukoencephalopathy;

D O I：

10.1007/s11904-009-0022-z

中图分类号：

学科分类号：

摘要：

A significant proportion of patients present with the immune reconstitution inflammatory syndrome (IRIS) after commencing antiretroviral therapy (ART). This syndrome is most frequently associated with infective causes. The lack of evidence-based treatment guidelines poses challenges in the management of these patients. Alternative causes for deterioration should be excluded, and optimization of treatment for the underlying opportunistic infection is essential. In addition, anti-inflammatory or immunomodulatory therapy may be considered, particularly in severe cases. Corticosteroids, the only treatment for which clinical trial data exist (for treating paradoxical tuberculosis-associated IRIS), are the treatment most frequently used in IRIS. Limited anecdotal reports of benefit exist for other agents, including NSAIDs, pentoxifylline, montelukast, thalidomide, and hydroxychloroquine. Therapeutic procedures (eg, aspiration of pus collections) play an important role in some patients. Interruption of ART may be considered in life-threatening forms of IRIS. © 2009 Current Medicine Group, LLC.

引用

页码：162 / 171

页数：9

共 52 条

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