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Immune reconstitution disease associated with parasitic infections following initiation of antiretroviral therapy

Lawn, Stephen Da,b

Current Opinion in Infectious Diseases: October 2007 - Volume 20 - Issue 5 - p 482–488
doi: 10.1097/QCO.0b013e3282a6463d
Tropical and travel-associated diseases

Purpose of review The aim of this article is to review the literature concerning immune reconstitution disease associated with parasitic infections during antiretroviral therapy.

Recent findings Immune reconstitution disease is most commonly associated with mycobacterial, chronic viral and invasive fungal infections. The spectrum of infections recognized to be associated with this phenomenon is expanding, however, and now includes a number of parasite infections (protozoal and helminthic). A total of 24 suspected cases have been reported in association with the following diseases: leishmaniasis in its various forms (visceral, cutaneous, mucosal and post-kala-azar dermal leishmaniasis), toxoplasmosis, cryptosporidiosis, schistosomiasis and strongyloidiasis. All cases associated with helminthic infections (schistosomiasis and strongyloidiasis) occurred in immigrants from tropical countries living in high-income countries; four of the patients with leishmaniasis were either immigrants or migrants who had moved out of endemic areas. As access to antiretroviral therapy expands in resource-limited settings, the clinical spectrum, frequency and impact of immune reconstitution disease associated with parasitic infections must be defined.

Summary Reports of immune reconstitution disease associated with parasitic infections are increasing, with many occurring in immigrants or migrants from areas where these diseases are endemic. The importance of such cases in antiretroviral therapy programmes in resource-limited settings, however, is not yet known.

aThe Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

bDepartment of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

Correspondence to Dr Stephen D. Lawn, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa Tel: +27 21 650 6957; fax: +27 21 650 6963; e-mail: stevelawn@yahoo.co.uk

© 2007 Lippincott Williams & Wilkins, Inc.