Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Patricia Price, D.M. Murdoch, U. Agarwal, S.R. Lewin, J.H. Elliott, Martyn French

    Research output: Contribution to journalLiterature review

    56 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)651-663
    JournalClinical Microbiology Reviews
    Volume22
    Issue number4
    DOIs
    Publication statusPublished - 1 Oct 2009

    Fingerprint

    Immune System Diseases
    Virus Diseases
    Polyomavirus Infections
    JC Virus
    T-Lymphocytes
    Immunocompetence
    Human Herpesvirus 3
    Hepatitis C Antibodies
    Opportunistic Infections
    Cellular Immunity
    Hepacivirus
    Hepatitis
    HIV-1
    Central Nervous System
    Cytokines
    Inflammation
    Liver
    Enzymes
    Therapeutics

    Cite this

    Price, Patricia ; Murdoch, D.M. ; Agarwal, U. ; Lewin, S.R. ; Elliott, J.H. ; French, Martyn. / Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms. In: Clinical Microbiology Reviews. 2009 ; Vol. 22, No. 4. pp. 651-663.
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    abstract = "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.",
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    Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms. / Price, Patricia; Murdoch, D.M.; Agarwal, U.; Lewin, S.R.; Elliott, J.H.; French, Martyn.

    In: Clinical Microbiology Reviews, Vol. 22, No. 4, 01.10.2009, p. 651-663.

    Research output: Contribution to journalLiterature review

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    AU - Price, Patricia

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