IRIS: A concern for people
starting HIV therapy

April 2008     View PDF     En español

What does the research show?

The research on predicting and diagnosing IRIS is still in its early stage, though more discovery releases new information every few months. Below is some recent study information.

Asthma medicine
A type of immune chemical, called a leukotriene, causes different types of inflammation. Drugs that reduce these levels in the body, called leukotriene inhibitors, are commonly used to treat asthma. Since it’s thought that leukotriene inhibitors affect other inflammation in the body, they may be useful for treating IRIS.

Encouraging results have been reported by doctors in London who used a common asthma medicine, Singulair (montelukast), to treat IRIS in a 59-year-old man. After five months off therapy, he restarted on a protease inhibitor regimen boosted with Norvir. IRIS appeared a few weeks later as a skin rash, and prednisone was used. His health improved somewhat but then the rash returned along with a fever and rapid heart beat. Singulair was prescribed and within five days his symptoms had settled.

The doctors suggest that leukotrienes may play a role in IRIS. Although this case does not prove that this therapy works, it may open up new research into using leukotrienes to treat IRIS. If this turns out to be true, then already approved drugs may be easily adapted to treat the condition.

Gene markers
Finding ways to diagnose earlier who will develop IRIS will allow for better strategies for its prevention and treatment. One study at CROI 2008 reported results of 28 people with and 38 without recent cryptococcal meningitis who started HIV therapy. Researchers looked at 85 genes that were related to cells of the immune response and reproduction of the meningitis. Results showed that using certain gene markers may help predict IRIS before it becomes a problem. More study is needed.

Immune markers in TB disease
One study at CROI 2008 reported disappointing results of finding immune markers that would adequately predict IRIS in TB disease. A Thai study showed that IL-12 and serum IL-2, among other markers, did not show differences between those who did and did not develop IRIS. However, a second study reported that they’re looking at other markers, such as regulatory and effector T cells, monocytes and macrophages. Results will be forthcoming.