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Description

Robertson et al listed criteria for the diagnosis of the immune reconstitution syndrome (IRS) in a patient receiving highly-active antiretroviral therapy (HAART). The authors are from the University of Cincinnati.


 

Required criteria:

(1) worsening symptoms of inflammation and/or infection

(2) onset after starting HAART

(3) >= 1 LOG10 decrease in plasma HIV load (10-fold decrease, or ratio of post-treatment count to pre-treatment count less than 0.1)

(4) symptoms not due to the onset of a newly acquired infection or disease

(5) symptoms not explained by the usual course of an existing disease

 

where:

• Criteria 4 and 5 are listed as a single criterion with a connecting OR.

• Criterion 5 can be interpreted in different ways. It may be referring to noninfectious conditions (criterion 4 specifies "infection or disease"). Since a patient with HIV does not have a normal immune system, any infection would not show a "usual" course?

 

Supportive criteria:

(1) an increase in CD4 positive lymphocytes >= 25 per µL

(2) A biopsy shows well-formed granulomatous inflammation or an unusually exuberant inflammatory response

 


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