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JAC Advance Access originally published online on September 26, 2006
Journal of Antimicrobial Chemotherapy 2006 58(5):1094-1095; doi:10.1093/jac/dkl390
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Correspondence

Immune reconstitution inflammatory syndrome: more answers, more questions—authors' response

S. A. Shelburne1, M. Montes1 and R. Hamill1,2,*

1 Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine 1 Baylor Plaza, Houston, TX 77030, USA 2 Department of Medicine, Section of Infectious Diseases (111G), Michael E. DeBakey Veterans Affairs Medical Center 2002 Holcombe Boulevard, Houston, TX 77030, USA

*Corresponding author. Tel: +1-713-794-7385; Fax: +1-713-794-7045; E-mail: richard.hamill{at}med.va.gov

Keywords: immune reconstitution inflammatory syndrome

Sir,

We thank Dr Zavascki1 for his thoughtful comments on our article concerning the immune reconstitution inflammatory syndrome (IRIS)2 and agree with his assessment that patients with prior antiretroviral treatment should not be excluded when considering the diagnosis or when trying to formulate an inclusive definition for the syndrome. It should be noted in Figure 1 of our article that the proposed criteria listed for the diagnosis of IRIS included ‘Receiving HAART’ and not just newly initiated HAART. Furthermore, in our previous report3 of risk factors for IRIS, being antiretroviral drug naive at the time of diagnosis of underlying opportunistic infection was a significant predictor of risk for the syndrome. However, there were still 7% of affected individuals (approximately 4) who developed IRIS and had received some previous antiretroviral therapy, but had recently initiated a new, effective regimen.

As we emphasized in our most recent article,2 complexities still exist in trying to formulate a workable diagnosis of IRIS. Recent attempts to solidify a definition are welcome,4 but when including potential cases of IRIS it is important to include not only naive patients starting a new regimen but also those whose therapy has been changed to one that is more active.

Transparency declarations

None to declare.

References

1 Zavascki AP. (2006) Comment on: Immune reconstitution inflammatory syndrome: more answers, more questions. J Antimicrob Chemother 58: doi:10.1093/jac/dkl362.

2 Shelburne SA, Montes M, Hamill RJ. (2006) Immune reconstitution inflammatory syndrome: more answers, more questions. J Antimicrob Chemother 57:167–70.[Abstract/Free Full Text]

3 Shelburne SA, Visnegarwala F, Darcourt J, et al. (2005) Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 19:399–406.[Web of Science][Medline]

4 Robertson J, Meier M, Wall J, et al. (2006) Immune reconstitution syndrome in HIV: validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis 42:1639–46.[CrossRef][Web of Science][Medline]


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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
58/5/1094-a    most recent
dkl390v1
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