Inflammatory reactions in HIV-1-infected persons after initiation of highly active antiretroviral therapy

Ann Intern Med. 2000 Sep 19;133(6):447-54. doi: 10.7326/0003-4819-133-6-200009190-00013.


Purpose: To review reported inflammatory reactions occurring after initiation of highly active antiretroviral therapy (HAART) in persons infected with HIV-1 and to explore the mechanisms leading to these reactions.

Data sources: MEDLINE search of biomedical literature reporting inflammatory reactions after HAART. Bibliographies of retrieved reports were also reviewed.

Study selection: Articles describing patients infected with HIV-1 who had immunologic and virologic responses to HAART and subsequently developed inflammatory reactions.

Data extraction: Data on the immune status, clinical characteristics, and therapeutic management of patients who were seropositive for HIV-1 and had inflammatory reactions after HAART.

Data synthesis: Inflammatory reactions involving opportunistic infections, AIDS-associated malignant conditions, and other noninfectious diseases have recently been described in patients infected with HIV-1. These conditions often appeared shortly after the introduction of HAART and were associated with pronounced reductions in plasma HIV-1 viral load and increases in CD4(+) T-lymphocyte counts. Clinical presentation was often atypical of that in patients with untreated HIV-1 infection, probably because of restored immunity. Most cases improved despite continuation of HAART, although some patients required anti-inflammatory drugs or specific antimicrobial agents.

Conclusions: Clinicians caring for patients who are infected with HIV-1 and receiving HAART must be aware of this new and diverse clinical syndrome. As more HAART recipients are studied, new presentations will probably be observed.

Publication types

  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis*
  • Autoimmune Diseases / diagnosis
  • CD4 Lymphocyte Count
  • Drug Therapy, Combination
  • HIV Infections / drug therapy*
  • HIV Infections / immunology*
  • HIV Infections / virology
  • HIV Protease Inhibitors / therapeutic use*
  • HIV-1* / genetics
  • Humans
  • Leukoencephalopathy, Progressive Multifocal / diagnosis
  • Neoplasms / diagnosis
  • RNA, Viral / blood
  • Reverse Transcriptase Inhibitors / therapeutic use*
  • Viral Load


  • HIV Protease Inhibitors
  • RNA, Viral
  • Reverse Transcriptase Inhibitors