Biomarkers of HIV immune reconstitution inflammatory syndrome

Dysregulation of the immune system drives HIV pathogenesis. As we develop new ways to treat HIV and AIDS, we encounter new clinical ramifications of our treatment on regulatory components of the immune system. HIV-associated immune reconstitution inflammatory syndrome (IRIS) occurs after the initiation of antiretroviral therapy with inappropriate and unbalanced restoration of the immune system, resulting in pathologic inflammatory reactions with significant morbidity. IRIS is most commonly associated with latent, occult or past infections, including tuberculosis, Cryptococcus neoformans and Mycobacterium avium complex. We discuss common clinical presentations, new diagnostic modalities, current hypotheses of IRIS pathogenesis and future directions of IRIS-related research, focusing on the identification of biomarkers that can be used to predict and diagnose IRIS.