Immune Reconstitution

Syndrome (IRS)
Blok 18 FK UKI

Tujuan
Setelah mengikuti kuliah ini,
diharapkan mahasiswa:
1. Memahami patofisiologi IRS
2. Memahami tanda & gejala klinis IRS
3. Mengetahui terapi IRS secara umum

Epidemiology
Large retrospective analysis examining all forms
of IRIS, 33/132 (25%) of patients exhibited one
or more disease episodes after initiation of ART.
Other cohort analyses examining all
manifestations of IRIS estimate that 1723% of
patients initiating ART will develop the
syndrome.
Another large retrospective study reported 32%
of patients with M. tuberculosis, M. avium
complex, or Cryptococcus neoformans
coinfection developed IRIS after initiating ART

Practical Definition: NACO

Occurrence or manifestations of
new OIs within six weeks to six
months after initiating ART; with
increase in CD4 count

Indias National AIDS Control Organization,

Antiretroviral Therapy Guidelines for HIVinfected Adults and Adolescents Including Postexposure Prophylaxis. May 2007

Onset of IRIS

5
Source: AIDS 2005, Vol 19 No4 ;399-406, Samuel A. Shelburne et al

HAART & HIV RNA Levels

6
Source: AIDS 2005, Vol 19 No4 ;399-406, Samuel A. Shelburne et al

IRIS & Non-IRIS Response to HAART

7
Source: AIDS 2005, Vol 19 No4 ;399-406, Samuel A. Shelburne et al

IRS in Thai children

(Pediatr Infect Dis J, 2006, Jan. 25 (1): 53-58)

Clinical Spectrum

Heterogeneous
Onset; early/delayed
Atypical symptoms; generalized/local
Varying severity
Infectious agents/site of infection

Risk Factors

Male sex
Younger age
Lower CD4 cell count at ART initiation
Higher HIV RNA at ART initiation
Lower CD4 cell percentage at ART initiation
Lower CD4:CD8 ratio at ART initiation
More rapid initial fall in HIV RNA on ART
Antiretroviral nave at time of OI diagnosis
Shorter interval between OI therapy initiation
and ART initiation

Patofisiologi

The infectious pathogens

Paling banyak: mycobacteria, varicella zoster,
herpesviruses, and cytomegalovirus (CMV)

Cryptococcus neoformans
Pneumocystis jirovecii pneumonia (PCP)
Histoplasmosis capsulatum
Toxoplasmosis
Hepatitis B virus
Hepatitis C virus
Progressive multifocal leukoencephalitis
Parvovirus B19
Strongyloides stercoralis infection & other parasitic infections
Molluscum contagiosum & genital warts
Sinusitis
Folliculitis

Non infectious etiologies

Rheumatologic/Autoimmune:
Rheumatoid arthritis, Systemic lupus
erythematosus (SLE)
Graves disease, Autoimmune thyroid disease
Sarcoidosis & granulomatous reactions
Tattoo ink
AIDS-related lymphoma
Guillain-Barre' syndrome (GBS)
Interstitial lymphoid pneumonitis

Treatment

Underlying diseases
NSAIDs/anti inflammation drugs
High dose of cortisone/predisone
Supporting therapy
Temporary cessation of ART (?)