Immune restoration diseases reflect diverse immunopathological mechanisms.

Journal Article (Journal Article;Review)

Up to one in four patients infected with human immunodeficiency virus type 1 and given antiretroviral therapy (ART) experiences inflammatory or cellular proliferative disease associated with a preexisting opportunistic infection, which may be subclinical. These immune restoration diseases (IRD) appear to result from the restoration of immunocompetence. IRD associated with intracellular pathogens are characterized by cellular immune responses and/or granulomatous inflammation. Mycobacterial and cryptococcal IRD are attributed to a pathological overproduction of Th1 cytokines. Clinicopathological characteristics of IRD associated with viral infections suggest different pathogenic mechanisms. For example, IRD associated with varicella-zoster virus or JC polyomavirus infection correlate with a CD8 T-cell response in the central nervous system. Exacerbations or de novo presentations of hepatitis associated with hepatitis C virus (HCV) infection following ART may also reflect restoration of pathogen-specific immune responses as titers of HCV-reactive antibodies rise in parallel with liver enzymes and plasma markers of T-cell activation. Correlations between immunological parameters assessed in longitudinal sample sets and clinical presentations are required to illuminate the diverse immunological scenarios described collectively as IRD. Here we present salient clinical features and review progress toward understanding their pathogeneses.

Full Text

Duke Authors

Cited Authors

  • Price, P; Murdoch, DM; Agarwal, U; Lewin, SR; Elliott, JH; French, MA

Published Date

  • October 2009

Published In

Volume / Issue

  • 22 / 4

Start / End Page

  • 651 - 663

PubMed ID

  • 19822893

Pubmed Central ID

  • PMC2772363

Electronic International Standard Serial Number (EISSN)

  • 1098-6618

Digital Object Identifier (DOI)

  • 10.1128/CMR.00015-09


  • eng

Conference Location

  • United States