Pathogenesis and prevention of immune reconstitution disease during antiretroviral therapy

Expert Rev Anti Infect Ther. 2011 Apr;9(4):415-30. doi: 10.1586/eri.11.21.


The risks of unmasking and paradoxical forms of immune reconstitution disease in HIV-infected patients starting antiretroviral therapy (ART) are fuelled by a combination of the late presentation of patients with advanced immunodeficiency, the associated high rates of opportunistic infections (OIs) and the need for rapid initiation of ART to minimize overall mortality risk. We review the risk factors and our current knowledge of the immunopathogenesis of immune reconstitution disease, leading to a discussion of strategies for prevention. Initiation of ART at higher CD4 counts, use of OI-preventive therapies prior to ART eligibility, intensified screening for OIs prior to ART initiation and optimum therapy for OIs are all needed. In addition, use of a range of pharmacological agents with immunosuppressive and immunomodulatory activity is being explored.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / prevention & control
  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active / methods
  • CD4 Lymphocyte Count
  • Clinical Trials as Topic
  • HIV / immunology*
  • HIV / pathogenicity
  • HIV Infections / drug therapy
  • HIV Infections / immunology*
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / etiology
  • Immune Reconstitution Inflammatory Syndrome / prevention & control*
  • Incidence
  • Risk Factors
  • Time Factors
  • Viral Load


  • Anti-HIV Agents