Синдром відновлення імунної системи: етіологія, патогенез, клінічні вияви

Abstract

Increasing of HIV-infection incidence in many countries of the world and in Ukraine in particular, late identification of patients and an increase in the power of antiretroviral therapy requires the doctors to treat the immune reconstitution inflammatory syndrome. The polymorphism of its manifestations and the delay in the onset of symptoms from the start of antiretroviral therapy make it difficult to diagnose this pathological condition timely and prescribe adequate treatment. In this work, a review of the literature on the problems of the immune reconstitution inflammatory syndrome has been conducted and the characteristics of it etiology, pathogenesis and clinical manifestations have been systematized. The main causes and mechanisms of the appearance of the unmasking and paradoxical forms of the immune reconstitution inflammatory syndrome were described. The global epidemiological data on the prevalence of immune reconstitution inflammatory syndrome and mortality from it various forms were analyzed. The main variants of the immune reconstitution inflammatory syndrome, namely tuberculosis\xadassociated immune reconstitution inflammatory syndrome, сryptococcus\xadassociated immune reconstitution inflam\xadmatory syndrome, and immune reconstitution inflammatory syndrome associated with Kaposi’s sarcoma, are considered. The most specific lesion sites, such as the central nervous system, skin, and mucous membranes were described. The criteria for the diagnosis of the most common forms of the immune reconstitution inflammatory syndrome were summarized. The main recommendations for the treatment and prevention of the immune reconstitution inflammatory syndrome, based on the world clinical researches, as well as expert opinions on the use of certain treatment methods for various conditions associated with the immune reconstitution inflammatory syndrome were presented. The main problems and future prospects of research in this direction were identified.