Immune reconstitution disease associated with parasitic infections following antiretroviral treatment

• Published in: Parasite Immunology Vol. 28; no. 11; pp. 625 - 633
• Main Authors: LAWN, S.D, WILKINSON, R.J
• Format: Journal Article
• Language: English
• Published: Oxford, UK Oxford, UK : Blackwell Publishing Ltd 01.11.2006; Blackwell Publishing Ltd
• Subjects: AIDS-Related Opportunistic Infections - immunology; Animals; Antiretroviral Therapy, Highly Active - adverse effects; antiretroviral treatment; HAART; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; Human immunodeficiency virus; Humans; immune reconstitution; immune reconstitution inflammatory syndrome; immune restoration; Immune System - drug effects; IRIS; Mycobacterium; Parasitic Diseases - complications; Parasitic Diseases - drug therapy; Parasitic Diseases - immunology; parasitic infection; Review; Schistosoma; Treatment Outcome; tropical infection
• ISSN: 0141-9838; 1365-3024; 1365-2567
• DOI: 10.1111/j.1365-3024.2006.00900.x

HIV-associated immune reconstitution disease (IRD) is the clinical presentation or deterioration of opportunistic infections that results from enhancement of pathogen-specific immune responses among patients responding to antiretroviral treatment (ART). The vast majority of reported cases of IRD have been associated with mycobacterial, chronic viral and invasive fungal infections; such cases result from dysregulated augmentation of cell-mediated type 1 cytokine-secreting host immune responses. However, the spectrum of infections now recognized as associated with IRD is expanding and includes a number of parasitic infections, which may be mediated by different immunopathological mechanisms. These include leishmaniasis (visceral, cutaneous, mucosal and post kala azar dermal leishmaniasis), schistosomiasis and strongyloidiasis. Since the major burden of HIV lies in resource-limited countries where access to ART is now rapidly expanding, increased awareness and knowledge of these phenomena is important. Here we review the clinical spectrum and pathogenesis of IRD associated with parasitic infections.