NAPLES, FLA. — Monitor patients who are starting effective highly active antiretroviral treatment for signs of immune reconstitution syndrome, Dr. Andrew Blauvelt advised at a symposium sponsored by the Dermatology Foundation.
Watch for infections caused by mycobacteria, cytomegalo-virus, herpes zoster, and staphylococcus. Eosinophilic folliculitis may also be seen in these patients. Sarcoidosis, acne, erythema nodosum, tattoo intolerance, and atopic dermatitis are among inflammatory consequences, Dr. Blauvelt said.
Immune reconstitution syndrome typically appears within the first 8 weeks of starting highly active antiretroviral treatment (HAART), particularly in patients with a low CD4 count. “The theory is that you have mycobacteria in you and your immune system is too weak to fight. But with HAART therapy, the body is finally able to mount an attack,” said Dr. Blauvelt, professor of dermatology at Oregon Health and Science University, Portland. He is also affiliated with the university's department of molecular microbiology and immunology.
In general, it is not necessary to alter the HAART regimen in a patient who develops the syndrome, Dr. Blauvelt said.
Instead, treat the syndrome with disease-specific strategies for infections and topical or systemic corticosteroids for inflammatory diseases.