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What is Immune Reconstitution Syndrome?

Rebuilding the Immune System Can Cause Problems


Updated June 11, 2014

LZ had been diagnosed with a CMV infection in the right eye. After several days of treatment, the eye infection improved and LZ was discharged from the hospital. A week later during a follow-up appointment with his HIV specialist, LZ was started on HIV medications. And why not? His eye was healed, he felt much better, and the goal afterall is to control HIV replication preserving the immune system in the process.

A Guide to CMV

After a couple weeks on his HIV regimen, LZ developed a fever, blurred vision, and swelling around his eye. The odd thing was that his CD4 count had gone up dramatically since starting HIV medications. So what was going on? His immune system was better, yet his eye looked horrible. LZ was seen by his doctor and was diagnosed with immune reconstitution syndrome. What is immune reconstitution syndrome? It sounds good so why did LZ have another severe eye infection? Let's take a look at this odd syndrome and try to make some sense out of it. The first step is to understand the immune system.

Know & Understand Your Immune System

Immune System Basics

The body has a built in defense mechanism that fights off infection and illness; the immune system. The body's immune system is comprised of several types of cells and processes that recognize and fight foreign invaders such as bacteria, parasites and viruses. Unfortunately, in people infected with HIV, the immune system is damaged, making it more difficult for the body to fight off these infections. How can we tell how healthy the immune system is? The answer is simple; by measuring the number of specialized immune system cells known as the CD4 cell. The higher the CD4 count the stronger the immune system.

Parts of the Immune System

What is a CD4 Count - Why is it Important?

How Do We Know the Immune System is Working?

When an infectious organism enters the body, a series of reactions occur that signal the immune system is working to fight off the infection. The reactions are collectively known as inflammation. Those inflammatory signs that the immune system is working include:
  • fever
  • swelling at the site of the injury or infection
  • redness of the site
  • thick drainage and discharge from the site of infection
  • warmth and pain at the site
In a damaged immune system some immune system functions may be absent.

What Is Immune Reconstitution?

Studies have shown that if HIV can be controlled by HIV medications, the immune system can repair itself. This immune rebuilding or reconstitution means that after repairing the damage done to the immune system, the body is better able to fight off those opportunistic infections that would otherwise make the person sick. As the HIV is controlled by medications, the body's CD4 count will rise, meaning the immune system is becoming stronger.

Opportunistic Infection Fact Sheets

What is Immune Reconstitution Syndrome?

Remember, if the body's immune system is damaged by HIV, the inflammatory process necessary for healing will not occur. That inflammatory process will return as the immune system is reconstituted. Take our example of LZ and his eye infection. Antibiotic treatment killed off much of the infectious organism responsible for the eye infection. Because LZ's immune system was damaged, the was no inflammatory process present; no redness, swelling, etc. When the HIV medications strengthened his immune system, the body sensed the remaining infectious organism in the eye, left behind after the antibiotic treatment was completed. Sensing the organisms, the newly reconstituted immune system triggered an inflammatory response, resulting in swelling, redness, discharge from the eye and fever. While LZ's immune system was healthier, his eye infection returned. This is the irony of immune reconstitution syndrome.

Is Immune Reconstitution Serious?
While immune reconstitution syndrome signals a healthier immune system, it can be a serious, sometimes fatal condition. Depending on the infection present, aggressive treatment is necessary to prevent serious illness. Common infections that occur during immune reconstitution include

What Can Be Done About Immune Reconstitution Syndrome?

Again, reconstituting the immune system is a good thing and while that process is desirable, the infection and inflammatory process present in immune reconstitution syndrome must be addressed. Treatment can include:
  • Continuation of the current HIV medication regimen.
  • Antibiotic or antiviral medications to treat the infection.
  • Steroids to temporarily suppress the inflammatory process.
Immune reconstitution syndrome is a complicated and confusing issue that has surfaced since the advent of HIV medications. If your doctor suggests you have reconstitution syndrome, ask a lot of questions and understand the syndrome and the plan of care completely before leaving his or her office.

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