Immune Restoration Disease After Antiretroviral Therapy

Martyn A. French; Patricia Price; Shelley F. Stone


AIDS. 2004;18(12) 

In This Article

Immune Restoration Disease in Developing Countries

Antiretroviral therapy is gradually being introduced into developing countries through the activities of agencies such as Medecins Sans Frontieres (MSF) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In one report on 743 patients in a MSF programme, all patients had baseline CD4 T-cell counts of < 200 × 106 cells/l and the median count was 48 × 106 cells/l.[146] There were therefore many patients at risk of developing infectious IRD. During an observation period of between 1.7 and 6.9 months, 8.2% of patients died, of whom 42.6% died during the first 30 days of therapy. While this may have reflected opportunistic infections complicating residual immunodeficiency, the findings of another study suggest that it may have been IRD. In a prospective study of 60 Thai patients with treated cryptococcal meningitis commencing HAART with CD4 T-cell counts between 0 and 147 × 106 cells/l, 20 episodes of 'opportunistic infection' occurred in 14 (23%) patients.[147] These occurred between 4 and 32 (median 16) weeks after commencing HAART and were associated with increased CD4 T cell counts. Disease was associated with infections by MTB, MAC, cryptococci, Toxoplasma, VZV and HSV and there were two deaths.


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