andtheImmuneReconstitutionInflammatorySyndrome(IRIS)：与免疫重建炎症综合征（IRIS）.pptVIP

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andtheImmuneReconstitutionInflammatorySyndrome(IRIS)：与免疫重建炎症综合征（IRIS）.ppt

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andtheImmuneReconstitutionInflammatorySyndrome(IRIS)：与免疫重建炎症综合征（IRIS）.ppt

Tuberculosis and the Immune Reconstitution Inflammatory Syndrome (IRIS) Bob Colebunders Definition ‘a paradoxical inflammatory reaction against a foreign antigen (alive or dead) in patients who have started antiretroviral therapy and who have undergone a reconstitution of their immune responses against this antigen’ Names Immune reconstitution inflammatory syndrome (IRIS) Immune restoration disease (IRD) Paradoxical reactions Pathogenesis Increased lymphoproliferative response to mycobacterium antigens in vitro Restoration of cutaneous response to Tuberculin Increased [Il-6], activation markers (CD38) Associated with TNFA-308*1, IL6-174*G Incidence TB/IRIS Europe and USA Narita et al 36% (Miami, 1998) Wendel et al 11% (Baltimore 2001) Breen et al 29% (London, 2004) Breton et al 43% (Paris, 2004) Incidence TB/IRIS Africa Breton et al: 41% No cases in TB/DOT study in South Africa (20 patients only) India Kumarasamy et al: IRIS of 15.2 cases per 100 patient-years Patel et al: TB IRIS more often in patients with active TB at the start of HAART than in those without active TB at the start of HAART (11 [8.73] vs. 3 [2.32%], respectively; p = 0.0489). Risk factors for TB/IRIS Starting ARV’s within 6 weeks of TB treatment Disseminated, extra-pulmonary disease Low base line CD4 count Rise in CD4 % Fall in viral load High bacillary burden? Types of TB IRIS Patient unknown to have TB at the start of HAART Patient on TB treatment before or at the start of HAART Timing of IRIS Mean of 15 days after starting HAART Up to months (years) Syndrome lasts for 10-40+ days TB IRIS TB IRIS TB IRIS TB IRIS TB IRIS TB IRIS Prognosis Breton et al: 16 cases of TB/IRIS: 5 ‘severe’ complications Splenic rupture Compressive lymphadenopathy Ureteric obstruction Narita et al: The study found a 6-fold increased risk of subsequent TB relapse in patients who experienced IRIS during early TB treatment. Cryptococcal meningitis treated with HAART, bilateral blindness: fundoscopy: bilat