39:
906:. There was worsened fever, weight loss, shortness of breath, and fatigue in patients with pulmonary tuberculosis and worsened skin lesions in patients with leprosy. Though the mechanism was unclear at the time, these observations were attributed to a pro-inflammatory state brought on by starting treatment.
137:
Though these symptoms can be dangerous, they also indicate that the body may now have a better chance to defeat the infection. The best treatment for this condition is unknown. In paradoxical IRIS reactions, the events will usually spontaneously get better with time without any additional therapy.
129:
by HIV (or by immunosuppressive drugs) causes a decrease in the body's normal response to certain infections. Not only does this make it more difficult to fight the infection, it may mean that a level of infection that would normally produce symptoms is instead undetected (subclinical infection). If
113:
opportunistic infection. The second is the “paradoxical” symptomatic relapse of a prior infection despite microbiologic treatment success. Often in paradoxical IRIS, microbiologic cultures are sterile. In either scenario, there is hypothesized reconstitution of antigen-specific T cell-mediated
476:
is the usual pathogen. Treatment with systemic corticosteroids during IRIS may be beneficial in preventing death or progressive neurological deterioration. Steroids given to persons with anti-fungal treatment failure / cryptococcal relapse (in whom CSF cultures are not sterile) can be a fatal
836:
are the most commonly used intervention in these cases as they work to suppress the inflammatory response seen in IRIS, though there is limited research on their efficacy. Guidelines recommend a risk/benefit analysis prior to starting corticosteroids, especially taking into consideration the
176:(OI). It is generally advised that when patients have a low initial CD4 T cell count and OI at the time of their HIV diagnosis, they receive treatment to control the OIs before HAART is initiated approximately two weeks later. This is true for most OIs, except for OIs involving the
799:
The differential diagnosis of IRIS is broad given its varied presentation. Conditions that can present similarly to IRIS are: adverse drug effects, progression of initial OI caused by medication resistance or patient non-adherence, and development of a new OI.
401:, environmental fungi which often affect immunocompetent hosts. Several weeks or even months into appropriate treatment, there is a sudden onset deterioration with worsening meningitis symptoms and progression or development of new neurological symptoms.
501:. A systemic inflammatory response may or may not be present. The majority of IRIS cases occur within 4 to 8 weeks of ART initiation or change. However, there have been reported cases from 3 days to several months or even years after ART initiation.
279:. In the immediate postpartum period (3 to 6 weeks), this process is reversed, resulting in a relative pro-inflammatory state. There is an increased risk of IRIS during this period. Common infections associated with IRIS in these patients include
259:. While the patient is immunosuppressed, these infections may remain latent and asymptomatic. However, when the ANC improves, the infections may become symptomatic and present as IRIS. Common infections associated with IRIS in these patients are
864:
except in the most severe cases of IRIS. Discontinuing ART may be considered in life-threatening cases of IRIS not improved by corticosteroids, usually in central nervous system-associated IRIS. Stopping ART increases the risk of acquiring new
924:
during hibernation, when the immune system is naturally suppressed to conserve energy through the winter. This study suggests that bats undergoing an intense inflammation at the site of infection after a return to euthermia is a form of IRIS.
367:. While the patient is taking TNF antagonists, these infections may remain latent and asymptomatic. However, when these medications are discontinued, there may be an associated pro-inflammatory response causing the infection to be uncovered.
81:
Systemic or local inflammatory responses may occur with improvement in immune function. While this inflammatory reaction is usually self-limited, there is risk of long-term symptoms and death, particularly when the
407:
shows increase in the size of brain lesions, and CSF abnormalities (white cell count, protein, glucose) increase. CSF culture is typically sterile, and there is no increase in CSF cryptococcal antigen titer.
223:, suppressing their function. IRIS in these patients is thought to be due to the pro-inflammatory response after withdrawal of immunosuppressants. Common infections associated with IRIS in these patients are
414:
The general mechanism behind IRIS is increased inflammation as the recovering immune system recognizes the antigens of the fungus as immunosuppression is reversed. Cryptococcal IRIS has three phases:
757:
The diagnosis of IRIS is clinical. There is no universal definition of IRIS, however there is general consensus that most of the following criteria should be met to make the diagnosis:
1402:"The poor prognosis of central nervous system cryptococcosis among nonimmunosuppressed patients: a call for better disease recognition and evaluation of adjuncts to antifungal therapy"
130:
the CD4 count rapidly increases (due to effective treatment of HIV, or removal of other causes of immunosuppression), a sudden increase in the inflammatory response produces
1895:
548:
2029:
1600:"Determinants of immune reconstitution inflammatory syndrome in HIV type 1-infected patients with tuberculosis after initiation of antiretroviral therapy"
1269:"Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome"
633:
78:
IRIS may also be referred to as immune reconstitution syndrome, immune reconstitution disease, immune recovery disease, and immune restoration disease.
832:
In severe IRIS, symptoms may cause permanent disability or death. Management again includes antimicrobial treatments against the underlying infection.
1215:"Clinical features and serum biomarkers in HIV immune reconstitution inflammatory syndrome after cryptococcal meningitis: a prospective cohort study"
849:, worsening of an existing infection, and increased risk of a new infection. Important exceptions include cases of Cryptococcal-IRIS with worsening
816:(NSAIDs) may be used to alleviate inflammatory symptoms, such as fever or pain. Abscess drainage, excision of painful and inflamed lymph nodes, and
470:
IRIS may be the cause of paradoxically worse outcomes for cryptococcal meningitis in immunocompetent compared with immunocompromised hosts, in whom
1799:"Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis"
918:(WNS) may be the first known natural occurrence of IRIS, in a report released by the USGS. WNS is typified by a cutaneous infection of the fungus
196:(HAART), also referred to as antiretroviral therapy (ART). However, IRIS can still occur in the following conditions that do not involve HIV:
1988:
1142:
164:
114:
immunity with activation of the immune system against persisting antigen, whether present as intact organisms, dead organisms, or debris.
1316:
Lane M, McBride J, Archer J (August 2004). "Steroid responsive late deterioration in
Cryptococcus neoformans variety gattii meningitis".
1703:"Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort"
1500:"Challenges in diagnosis and management of Cryptococcal immune reconstitution inflammatory syndrome (IRIS) in resource limited settings"
813:
1923:"Pathology in euthermic bats with white nose syndrome suggests a natural manifestation of immune reconstitution inflammatory syndrome"
352:
1361:"Paradoxical inflammatory reaction during treatment of Cryptococcus neoformans var. gattii meningitis in an HIV-seronegative woman"
2024:
898:
IRIS was discovered in the 1980s when physicians noted paradoxical symptomatic worsening of patients being treated for pulmonary
1641:"Incidence and risk factors of immune reconstitution inflammatory syndrome complicating HIV-associated cryptococcosis in France"
846:
284:
1747:"Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy"
1899:
962:"Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy"
934:
920:
939:
1451:"Cryptococcus-Related Immune Reconstitution Inflammatory Syndrome(IRIS): Pathogenesis and Its Clinical Implications"
1167:
Sun HY, Singh N (August 2009). "Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients".
1099:. New York State Department of Health AIDS Institute Clinical Guidelines. Baltimore (MD): Johns Hopkins University.
771:
404:
155:
89:
Management generally involves symptom control and treatment of the underlying infection. In severe cases of IRIS,
569:
244:
189:
433:
immune recovery, with pro-inflammatory signaling by antigen-presenting cells without an effector response; and
866:
564:
Typically worsening meningitis symptoms (rapid hearing/vision loss, ataxia, elevated intracranial pressure)
490:
472:
392:
379:
248:
173:
160:
68:
1896:"White-Nose Syndrome Bat Recovery May Present Challenges Similar to Those in Some Recovering AIDS Patients"
1745:
Shelburne SA, Hamill RJ, Rodriguez-Barradas MC, Greenberg SB, Atmar RL, Musher DW, et al. (May 2002).
887:
861:
718:
642:
619:
494:
208:
193:
177:
83:
786:
204:
1498:
Musubire AK, Meya BD, Mayanja-Kizza H, Lukande R, Wiesner LD, Bohjanen P, R Boulware RD (June 2012).
960:
Shelburne SA, Visnegarwala F, Darcourt J, Graviss EA, Giordano TP, White AC, Hamill RJ (March 2005).
812:
For mild symptoms, treatment is focused on treating the underlying infection and symptom management.
789:, patient non-adherence, or reduced serum drug levels (from drug-drug interactions or malabsorption).
714:
312:
131:
1701:
Haddow LJ, Easterbrook PJ, Mosam A, Khanyile NG, Parboosing R, Moodley P, Moosa MY (November 2009).
146:
drugs against the infectious organism. In some severe cases, anti-inflammatory medications, such as
1598:
Breton G, Duval X, Estellat C, Poaletti X, Bonnet D, Mvondo Mvondo D, et al. (December 2004).
915:
854:
654:
423:
387:
98:
38:
1213:
Boulware DR, Meya DB, Bergemann TL, Wiesner DL, Rhein J, Musubire A, et al. (December 2010).
2034:
1776:
1670:
1423:
1341:
1192:
991:
692:
460:
363:
formation. Therefore, TNF antagonists impair the host immune response against infections such as
328:
304:
857:. In these cases, corticosteroids should not be used as they have been shown to worsen outcomes.
702:
324:
1976:
1267:
Boulware DR, Bonham SC, Meya DB, Wiesner DL, Park GS, Kambugu A, et al. (September 2010).
2019:
1994:
1984:
1952:
1877:
1828:
1768:
1724:
1662:
1621:
1580:
1529:
1480:
1431:
1382:
1333:
1298:
1246:
1184:
1138:
1100:
1058:
983:
883:
554:
May be indistinguishable from active MAC infection (pulmonary disease, systemic inflammation)
60:
27:
1942:
1934:
1867:
1859:
1818:
1810:
1758:
1714:
1652:
1611:
1570:
1560:
1519:
1511:
1470:
1462:
1413:
1372:
1325:
1288:
1280:
1236:
1226:
1176:
1130:
973:
504:
The following table describes the major and minor presentations in reported underlying OIs.
441:
275:
During pregnancy, the immune system is relatively suppressed to prevent fetal rejections or
300:
256:
228:
1657:
1640:
978:
961:
1947:
1922:
1872:
1847:
1823:
1798:
1575:
1548:
1524:
1499:
1475:
1450:
1329:
1293:
1268:
1241:
1214:
1134:
879:
833:
817:
782:
613:
559:
437:
288:
280:
224:
147:
143:
94:
90:
1814:
778:
Decrease in HIV-1 RNA levels from baseline or increase in CD4 count after starting ART
729:
Usually presents similarly to non-IRIS disease, but may have relatively worse symptoms
489:
The clinical presentation of IRIS is variable and typically depends on the underlying
247:(ANC) is less than 500 per microliter, there is an increased risk of fungal and viral
192:
in the 1980s, IRIS is now mostly associated with the initiation of HIV treatment with
2013:
1763:
1746:
1196:
838:
684:
679:
336:
260:
220:
64:
1846:
Bahr N, Boulware DR, Marais S, Scriven J, Wilkinson RJ, Meintjes G (December 2013).
1780:
1674:
1345:
1125:
Bohjanen PR, Boulware DR (2008). "HIV Immune
Reconstitution Inflammatory Syndrome".
995:
899:
842:
821:
740:
588:
Presence of vitritis or uveitis may help distinguish IRIS from active CMV retinitis
525:
498:
478:
364:
292:
232:
72:
1093:
Brust JC, McGowan JP, Fine SM, Merrick ST, Radix AE, Vail RM, et al. (2021).
942:, another systemic inflammatory syndrome that arises after antimicrobial treatment
1231:
1180:
448:
Three clinical predictors of cryptococcal-related paradoxical IRIS risk include:
698:
604:
600:
493:. Common features that may be present include clinical worsening after starting
453:
332:
276:
264:
252:
216:
1094:
1050:
739:
Appearance or worsening of a variety of dermatologic manifestations, including
385:
IRIS has been described in immunocompetent hosts who have meningitis caused by
134:
such as fever, and in some cases a worsening of damage to the infected tissue.
1998:
1863:
1639:
Lortholary O, Fontanet A, MĂ©main N, Martin A, Sitbon K, Dromer F (July 2005).
1466:
850:
666:
356:
348:
344:
340:
212:
139:
32:
150:
are needed to suppress inflammation until the infection has been eliminated.
110:
1797:
MĂĽller M, Wandel S, Colebunders R, Attia S, Furrer H, Egger M (April 2010).
623:
576:
360:
1956:
1881:
1832:
1772:
1728:
1666:
1625:
1584:
1533:
1484:
1435:
1386:
1337:
1302:
1250:
1188:
1104:
1062:
987:
163:. Persons living with AIDS are more at risk for IRIS if they are starting
1515:
890:
has generally been associated with the highest mortality rates (13-75%).
882:
of 4.5%. Mortality rates vary and depend on the associated OI, degree of
853:
symptoms (cranial nerve defects, hearing or vision changes) and cases of
769:
count, typically <100 cells/microL. An exception is in the setting of
762:
93:
are commonly used. Important exceptions to using corticosteroids include
56:
775:
infection, which can be reactivated with CD4 cells >200 cells/microL.
109:
There are two common IRIS scenarios. The first is the “unmasking” of an
1938:
1565:
1427:
903:
837:
patient’s comorbidities. Common adverse effects of corticosteroids are
580:
296:
1549:"Immune reconstitution inflammatory syndrome in HIV-infected patients"
618:
Flares are typically mild and self-limited, presenting with transient
585:
Retinitis usually occurs at the site of previous CMV retinitis lesions
126:
1848:"Central nervous system immune reconstitution inflammatory syndrome"
1719:
1702:
1616:
1599:
1418:
1401:
1377:
1360:
1284:
75:
response that paradoxically makes the symptoms of infection worse.
430:
419:
308:
824:
from mild pulmonary inflammation may also be used when indicated.
172:
for the first time, or if they have recently been treated for an
1547:
Walker NF, Scriven J, Meintjes G, Wilkinson RJ (February 2015).
1096:
795:
Temporal association between initiation of ART and symptom onset
744:
411:
The increasing inflammation can cause brain injury or be fatal.
766:
138:
In unmasking IRIS, the most common treatment is to administer
123:
67:
begins to recover, but then responds to a previously acquired
726:
Reactivation of HSV and VZV, even if not previously diagnosed
165:
1400:
Ecevit IZ, Clancy CJ, Schmalfuss IM, Nguyen MH (May 2006).
792:
Clinical symptoms consistent with an inflammatory condition
886:, geography, and access to treatment. IRIS affecting the
669:
and oral, gastric, lung, genital, or conjunctival lesions
207:(liver, kidney, pancreas, etc.), patients are prescribed
1898:(Press release). USGS. November 19, 2012. Archived from
538:
Enlarging lymph nodes which may cause airway obstruction
153:
Infections most commonly associated with IRIS include
101:, as they have been associated with poorer outcomes.
697:
Flares of existing autoimmune conditions, including
466:
failure to sterilize the CSF before immune recovery.
426:(CSF) inflammation and defects in antigen clearance;
781:No evidence of drug-resistant infection, bacterial
26:
21:
2003:Immune Reconstitution Inflammatory Syndrome (IRIS)
1979:. In Bolognia J, Schaffer JV, Cerroni L (eds.).
1921:Meteyer CU, Barber D, Mandl JN (November 2012).
1359:Einsiedel L, Gordon DL, Dyer JR (October 2004).
662:Worsening of KS, most commonly cutaneous lesions
1057:. Treasure Island (FL): StatPearls Publishing.
323:Patients with chronic inflammatory conditions (
1208:
1206:
869:and developing IRIS again when restarting ART.
320:Patients on tumor necrosis factor antagonists
1262:
1260:
1051:"Immune Reconstitution Inflammatory Syndrome"
1044:
1042:
1040:
541:Meningeal symptoms (headache, neck stiffness)
8:
1088:
1086:
1084:
1082:
1080:
1078:
1038:
1036:
1034:
1032:
1030:
1028:
1026:
1024:
1022:
1020:
1977:"Cutaneous Manifestations of HIV Infection"
1011:Immune reconstitution inflammatory syndrome
910:In bats recovering from white-nose syndrome
626:in the setting of underlying liver disease.
382:as IRIS is fairly common and can be fatal.
49:Immune reconstitution inflammatory syndrome
22:Immune reconstitution inflammatory syndrome
1983:. Elsevier Health Sciences. p. 1378.
634:Progressive multifocal leukoencephalopathy
37:
18:
1946:
1871:
1822:
1762:
1718:
1656:
1615:
1574:
1564:
1523:
1474:
1449:Wiesner DL, Boulware DR (December 2011).
1417:
1376:
1292:
1240:
1230:
977:
672:Cases of fatal KS-IRIS have been reported
593:May cause rapid and permanent vision loss
506:
440:with a predominant type-1 helper T-cell
55:) is a condition seen in some cases of
952:
736:Nonspecific dermatologic complications
1553:HIV/AIDS: Research and Palliative Care
1169:Current Opinion in Infectious Diseases
456:(i.e. low CSF white blood cell count);
118:In HIV infection and immunosuppression
1792:
1790:
1740:
1738:
1696:
1694:
1692:
1690:
1688:
1686:
1684:
814:Non-steroidal anti-inflammatory drugs
612:May be difficult to distinguish from
7:
1162:
1160:
1158:
1156:
1154:
1120:
1118:
1116:
1114:
378:IRIS is particularly problematic in
194:highly active antiretroviral therapy
1658:10.1097/01.aids.0000174450.70874.30
979:10.1097/01.aids.0000161769.06158.8a
512:Underlying opportunistic infection
2030:Virus-related cutaneous conditions
1852:Current Infectious Disease Reports
1330:10.1212/01.wnl.0000134677.29120.62
1273:The Journal of Infectious Diseases
1135:10.1016/B978-1-4160-2882-6.50022-8
647:New or worsened PML lesions on MRI
315:may also occur during this period.
200:Solid organ transplant recipients
14:
1975:Chan RK, Chio MT, Koh HY (2018).
687:(aka toxoplasmosis encephalitis)
1764:10.1097/00005792-200205000-00005
1455:Current Fungal Infection Reports
641:May present as new or worsening
261:invasive pulmonary aspergillosis
1803:The Lancet. Infectious Diseases
1009:Wolfe C (2023). Post TW (ed.).
570:Cytomegalovirus (CMV) retinitis
532:Worsening of pulmonary symptoms
335:, etc.) are often treated with
184:In individuals without HIV/AIDS
860:It is recommended to continue
1:
1815:10.1016/S1473-3099(10)70026-8
535:Worsening TB disease on X-ray
1707:Clinical Infectious Diseases
1604:Clinical Infectious Diseases
1406:Clinical Infectious Diseases
1365:Clinical Infectious Diseases
1232:10.1371/journal.pmed.1000384
1181:10.1097/QCO.0b013e32832d7aff
1049:Thapa S, Shrestha U (2022).
935:List of cutaneous conditions
921:Pseudogymnoascus destructans
309:systemic lupus erythematosus
940:Jarisch-Herxheimer reaction
549:Mycobacterium Avium complex
219:. These medications target
2051:
772:Mycobacterium tuberculosis
622:. May cause decompensated
405:Magnetic resonance imaging
374:In cryptococcal meningitis
359:activation and subsequent
156:Mycobacterium tuberculosis
1864:10.1007/s11908-013-0378-5
1467:10.1007/s12281-011-0064-8
708:
643:focal neurologic deficits
519:
263:and chronic disseminated
245:absolute neutrophil count
1127:Global HIV/AIDS Medicine
1013:. Waltham, MA: UpToDate.
249:opportunistic infections
209:immunosuppressive agents
2025:Immune system disorders
1504:African Health Sciences
818:inhaled corticosteroids
620:transaminase elevations
560:Cryptococcal meningitis
473:Cryptococcus neoformans
394:Cryptococcus neoformans
380:cryptococcal meningitis
174:opportunistic infection
161:cryptococcal meningitis
95:Cryptococcal meningitis
69:opportunistic infection
888:central nervous system
765:with low pretreatment
719:Varicella zoster virus
680:Cerebral toxoplasmosis
665:May also present with
614:drug-induced hepatitis
353:Tumor necrosis factors
205:solid organ transplant
178:central nervous system
84:central nervous system
914:Bats recovering from
847:mental status changes
787:adverse drug reaction
497:and localized tissue
305:autoimmune conditions
240:Neutropenic patients
71:with an overwhelming
1516:10.4314/ahs.v12i2.23
1129:. pp. 193–205.
878:IRIS has a reported
715:Herpes simplex virus
709:Minor presentations
520:Major presentations
515:IRIS signs/symptoms
452:lack of initial CSF
422:, with a paucity of
313:rheumatoid arthritis
285:human papillomavirus
272:Postpartum patients
132:nonspecific symptoms
916:white-nose syndrome
743:, oral and genital
693:Autoimmune diseases
508:
424:cerebrospinal fluid
388:Cryptococcus gattii
122:The suppression of
1939:10.4161/viru.22330
1566:10.2147/HIV.S42328
507:
485:Signs and symptoms
461:C-reactive protein
329:ulcerative colitis
1990:978-0-7020-6342-8
1902:on April 26, 2020
1651:(10): 1043–1049.
1610:(11): 1709–1712.
1412:(10): 1443–1447.
1144:978-1-4160-2882-6
884:immunosuppression
750:
749:
203:After undergoing
190:HIV/AIDS epidemic
61:immunosuppression
46:
45:
16:Medical condition
2042:
2005:
1961:
1960:
1950:
1918:
1912:
1911:
1909:
1907:
1892:
1886:
1885:
1875:
1843:
1837:
1836:
1826:
1794:
1785:
1784:
1766:
1742:
1733:
1732:
1722:
1713:(9): 1424–1432.
1698:
1679:
1678:
1660:
1636:
1630:
1629:
1619:
1595:
1589:
1588:
1578:
1568:
1544:
1538:
1537:
1527:
1495:
1489:
1488:
1478:
1446:
1440:
1439:
1421:
1397:
1391:
1390:
1380:
1356:
1350:
1349:
1313:
1307:
1306:
1296:
1264:
1255:
1254:
1244:
1234:
1225:(12): e1000384.
1210:
1201:
1200:
1164:
1149:
1148:
1122:
1109:
1108:
1090:
1073:
1072:
1070:
1069:
1046:
1015:
1014:
1006:
1000:
999:
981:
957:
855:Kaposi's sarcoma
685:Cerebral abscess
655:Kaposi's sarcoma
551:(MAC) infection
509:
442:interferon-gamma
355:are critical in
221:CD4 immune cells
171:
167:
99:Kaposi’s sarcoma
42:
41:
19:
2050:
2049:
2045:
2044:
2043:
2041:
2040:
2039:
2010:
2009:
2008:
1991:
1974:
1970:
1968:Further reading
1965:
1964:
1920:
1919:
1915:
1905:
1903:
1894:
1893:
1889:
1845:
1844:
1840:
1796:
1795:
1788:
1744:
1743:
1736:
1700:
1699:
1682:
1638:
1637:
1633:
1597:
1596:
1592:
1546:
1545:
1541:
1497:
1496:
1492:
1448:
1447:
1443:
1399:
1398:
1394:
1358:
1357:
1353:
1315:
1314:
1310:
1266:
1265:
1258:
1212:
1211:
1204:
1166:
1165:
1152:
1145:
1124:
1123:
1112:
1092:
1091:
1076:
1067:
1065:
1048:
1047:
1018:
1008:
1007:
1003:
959:
958:
954:
949:
931:
912:
896:
876:
834:Corticosteroids
806:
755:
703:Grave’s disease
579:, vitritis, or
487:
429:during initial
376:
337:TNF antagonists
325:Crohn's disease
303:. Flare-ups of
301:viral hepatitis
229:cytomegalovirus
186:
169:
148:corticosteroids
120:
107:
91:corticosteroids
63:, in which the
36:
17:
12:
11:
5:
2048:
2046:
2038:
2037:
2032:
2027:
2022:
2012:
2011:
2007:
2006:
1989:
1971:
1969:
1966:
1963:
1962:
1933:(7): 583–588.
1913:
1887:
1858:(6): 583–593.
1838:
1809:(4): 251–261.
1786:
1757:(3): 213–227.
1734:
1720:10.1086/630208
1680:
1631:
1617:10.1086/425742
1590:
1539:
1510:(2): 226–230.
1490:
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454:pleocytosis
436:at IRIS, a
333:sarcoidosis
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253:Aspergillus
231:(CMV), and
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1068:2023-02-09
1055:StatPearls
947:References
851:meningitis
808:Mild IRIS
804:Management
717:(HSV) and
667:lymphedema
479:iatrogenic
357:macrophage
349:etanercept
345:adalimumab
341:infliximab
339:, such as
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188:Since the
140:antibiotic
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1927:Virulence
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753:Diagnosis
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459:elevated
444:response.
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243:When the
144:antiviral
105:Mechanism
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581:uveitis
481:error.
418:before
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657:(KS)
431:HAART
420:HAART
396:var.
166:HAART
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1985:ISBN
1953:PMID
1908:2020
1878:PMID
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1769:PMID
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1663:PMID
1645:AIDS
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