Immune reconstruction syndrome D89.3

Side effect of HAART therapy in mostly advanced HIV infection (< 200 CD4 cells/µl; high HIV load). This immune reconstitution reaction occurs in up to 25% of infected persons. In this case, despite increasing T-helper cells, there is a temporary clinical worsening of the disease state.

Activation of latent subclinical infections; occurrence of opportunistic infections such as zoster, mucocutaneous herpes simplex infections, mycobacterioses (see below tuberculosis) and leishmanioses. Sterile eosinophilic pustuloses, foreign body granulomas, cutaneous sarcoidoses, acute porphyrias(see porphyria below) and pityriasis rubra pilaris may also worsen significantly or become clinically evident for the first time on HAART. HHV-associated Kaposi's sarcomas may worsen during IRS.

Similarly, autoimmune diseases such as lupus erythematosus, Sweet's syndrome and Reiter 's syndrome have been described.

An analogous "reconstitution syndrome" - eruption of lymphocyte recover- may occur after aggressive myoablative chemotherapy.

1. Esser S (2007) Side effects of HIV therapy. JDDG 5: 745-755
2. Friedler Set al (1999) Atypical cutaneous lymphoproliferative disorder in patients with HIV infection. Int J Dermatol 38:111-118.
3. French MA et al (2000) Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active ativiral therapy. HIV Med 1: 107-115