|
Measure
|
Immune Deficient
|
Immune Restoration
|
|
absolute CD4 lymphocyte count
|
low
|
increase
|
|
response to vaccines
|
no antibody response
|
develops antibody response
|
|
response to delayed type hypersensitivity skin test
|
anergy
|
responsive
|
|
prophylactic therapy against opportunistic pathogens
|
needs
|
can discontinue
|
|
HIV viral loads
|
high
|
undetectable while on therapy
|
Immune Restoration Disease refers to clinical deterioration in patients as they become able to respond to occult infections. It tends to occur during the first 6 months of HAART therapy and may be associated with reactions to:
(1) Mycobacterium avium-intracellulare complex (lymphadenopathy, other)
(2) Cytomegalovirus (usually retinitis)
(3) Herpes zoster
(4) viral hepatitis B or C
(5) Mycobacterium tuberculosis
(6) Herpes simplex
(7) JC virus
(8) Cryptococcus neoformans
(9) Kaposi's sarcoma
Differential diagnosis:
(1) failure in drug regimen due to resistance (relapse of occult infection)
(2) new opportunistic infection associated with partially restored but defective immunity
(3) adverse drug reaction
For patients with immune restoration:
(1) corticosteroids may be beneficial
(2) HAART therapy should be continued (patients with viral hepatitis or Kaposi's sarcoma may benefit from holding therapy temporarily)
(3) if effective therapy is available for the underlying process, then this should be considered (antifungal, antimycobacterial, anti-CMV)
(4) analgesics
