Pathogenesis of the immune reconstitution inflammatory syndrome affecting the central nervous system in patients infected with HIV

Brain. 2011 Apr;134(Pt 4):928-46. doi: 10.1093/brain/awq365. Epub 2011 Jan 18.


Anti-retroviral therapy partially restores the immune function of patients infected with human immunodeficiency virus, thereby drastically reducing morbidity and mortality. However, the clinical condition of a subset of patients on anti-retroviral therapy secondarily deteriorates due to an inflammatory process termed immune reconstitution inflammatory syndrome. This condition results from the restoration of the immune system that upon activation can be detrimental to the host. Among the various clinical manifestations, central nervous system involvement is associated with greater morbidity and mortality. This review covers the pathogenesis of this novel neuroinflammatory disease, including the nature of the provoking pathogens and the composition and specificity of the evoked immune responses. Our current perception of this neuroinflammatory disease supports therapeutic strategies aimed at modulating immune aggression without dampening the life-saving restoration of the immune response.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Central Nervous System / immunology*
  • Central Nervous System / pathology
  • HIV Infections / complications*
  • HIV Infections / immunology
  • HIV Infections / pathology
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / etiology*
  • Immune Reconstitution Inflammatory Syndrome / immunology
  • Immune Reconstitution Inflammatory Syndrome / pathology