Immune Reconstitution Syndrome

About one person out of every five who starts antiretroviral therapy begins to get sick even as their immune system gets stronger. This is called immune reconstitution syndrome or sometimes immune restoration inflammatory syndrome.

The syndrome usually happens to people with very weak immune systems about two months after they start treatment for HIV. In some cases, an old infection returns. In other cases, a new disease starts.

When CD4 cell counts rise quickly and viral load drops, the body may fight the germs that were already there. This makes it seem as if the infection is new. In reality, the body was simply too weak to fight germs before therapy.

Symptoms

Symptoms of immune reconstitution syndrome depend on what infection the body is fighting. Some patients have fever and swollen lymph nodes. Others have swelling and tenderness in other parts of their bodies. Some of the infections that have been linked to immune reconstitution syndrome are:

• Cytomegalovirus

• Hepatitis B and C

• Shingles and herpes outbreaks

• Molluscum, which is a skin infection

• Mycobacterium Avium Complex (MAC). MAC during immune recovery may show unusual symptoms.

• Progressive multifocal leucoencephalopathy (PML), a viral brain

• Swollen lymph nodes (lymphadenopathy). This is a signal that the bodyÕs immune responses have become active.
  
• Tuberculosis

Causes

This syndrome is caused by a recovery of the bodyÕs immune system after it has become very weak. Before treatment, the body had infections but was not able to fight them. When the immune system quickly gets stronger, it attacks the infections.

The syndrome is more often linked to the infections listed above than other types of diseases or conditions.

Prevention

The best way to help avoid immune reconstitution syndrome is to get treatment for HIV before the immune system gets too weak.

Diagnosis

Following the start of antiretroviral treatment, a doctor will monitor a person with HIV. An infection that develops after treatment begins will be diagnosed on the basis of its symptoms and blood tests or culture that would be done to diagnose the underlying infection.

Treatment

Usually continuing HIV treatment takes care of any infections that emerge. The appearance of immune reconstitution syndrome is actually a good sign. It means the immune system is being restored.

In some cases, a doctor may slow down the recovery of the immune system. Using a steroid drug like prednisone can do this. Prednisone can ease the inflammation in the body as the immune system gets stronger. By slowly strengthening the immune system, some of the immune restorations responses can be avoided.