Coverage of 2008
International AIDS Conference

August 3–8, 2008, Mexico City, Mexico

Oral conditions and immune markers
may help better define IRIS

by Alan McCord, August 6, 2008

A serious condition called immune reconstitution inflammatory syndrome, or IRIS, may occur in people who start HIV therapy for the first time, or in people who start at very low CD4 counts. This occurs when the immune system recovers too quickly after the start of therapy by overworking and reacting to other infections that are present. It’s more likely to occur in those whose CD4 counts are below 100 before therapy and whose viral loads drop faster within the first month on therapy.

This study, presented at the International AIDS Conference in Mexico City, followed 95 individuals from September 2003 to March 2005 in a specialized AIDS clinic in Mexico City. Each had an oral exam and blood draw directly before starting HAART and at 4, 8 and 12 weeks afterwards. To be considered for analysis, volunteers had to achieve either a 1 log drop in viral load within the first 8 weeks or a 1 log drop each month and a sustained increase of CD4 cells of 50 after starting HAART.

A total of 71 volunteers completed the study. After starting HAART, 8 showed oral signs of disease: 2 with candidiasis, 2 with recurring ulcers, 3 with hairy leukoplakia and 1 with KS. In each case, there was a faster drop in viral loads at week 4 than those who didn’t show symptoms of disease. These 8 also had increases in their CD4 percentages and CD8 counts that were not seen in those with a satisfactory response to HAART.

The researchers concluded that the 8 who showed oral signs of disease after starting HAART may represent possible cases of IRIS, as opposed to having a new opportunistic infection while being on HAART. This conclusion was supported by the lack of oral symptoms in study volunteers who experienced good reductions in HIV levels without significant gains in CD4s, who also developed new opportunistic illnesses during the study.

While much progress has been made in the treatment of HIV disease, IRIS remains largely a mystery. There isn’t yet a universally accepted definition for IRIS, and no standard method of diagnosing or treating it. Much more work needs to be done to better understand its causes, and how best to diagnose and even treat it. This study may help contribute to a better understanding of IRIS. For more information on IRIS, read Project Inform’s publication, Immune Reconstitution Inflammatory Syndrome.