Immune Reconstitution Inflammatory Syndrome and Hodgkin’s Lymphoma

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is defined as a clinically significant exacerbation of known oligosymptomatic serious, more often infectious, diseases with considerably increased CD4+ T-lymphocyte count in response to highly active anti-retroviral therapy (HAART) of HIV infection. The review comprehensively discusses tuberculosis issues in HIV-positive HAART recipients. Related recommendations contain strict guidelines on compulsory treatment of tuberculosis prior to HAART assignment. Similar recommendations for specific therapy preceding HAART are provided for other opportunistic infections (mycotic and cryptococcal infections, parasitosis, molluscum contagiosum, toxoplasmosis, herpes-zoster virus, leishmaniasis, syphilis, and lepra). Without prior specific therapy of an opportunistic infection its exacerbation with pronounced symptoms and signs on HAART can be fatal for the patient. Lymphomas including Hodgkin’s lymphoma (HL) are dealt with in the context of the same challenge. However, what remains unclear is the specificity of targeted T-lymphocytes in the microenvironment to hitherto unclarified cause-specific antigens of the tumor. As opposed to other malignant lymphoid tumors arising with low level of CD4+ T-lymphocytes, HL develops when the level of CD4+ T-lymphocytes is increased in response to HAART in HIV-positive patients during the first months of anti-retroviral therapy. HL is diagnosed in 8 % of HIV-positive off-HAART subjects. After HAART assignment the HL incidence goes up to 17 %. Therefore, IRIS can be considered the main challenge in the study of etiology and pathogenesis of HL in HIV-positive patients. In this context, the demand to extend the research in this field becomes not only obvious but crucial for practical applications.