Cases of HIV/AIDS increased rapidly in the developed world in the 1980s.60 Decades later, the widespread use of anti-PCP prophylaxis, the changing demographics of the HIV-positive population, and the tremendous advancement in the management of HIV/AIDS in the developed world with the advent of highly active antiretroviral therapy (HAART) have contributed to the changing spectrum of HIV-related infections. Rates of AIDS-defining malignancies such as Kaposi's sarcoma and non-Hodgkin's lymphoma have also decreased.
In resource-limited settings, AIDS-related infectious complications such as P. jiroveci pneumonia and pulmonary tuberculosis still predominate. In the developed and developing world settings, bacterial infections have now become the commonest infectious thoracic complication in the HIV population. Aetiologically, S. pneumoniae predominates, followed by H. influenzae.
Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients with mycobacterial infections starting highly active antiretroviral therapy is defined as an exacerbation of symptoms, signs, or radiological manifestations of a pathogenic antigen, which are not due to relapse or recurrence. Patients affected with IRIS undergo deterioration in their clinical status at a time when viral replication appears to be under control and CD4 counts are rising, known as a paradoxical response. These paradoxical reactions have been reported to occur in patients with both infectious and non-infectious antigens.
The most common imaging features of IRIS consist of mediastinal lymph node enlargement, with central low attenuation, diffuse and bilateral pulmonary nodules and small pleural effusions (Fig. 1).
FIGURE 1 ■ Immune reconstitution inflammatory syndrome (IRIS) in a patient with tuberculosis. Posteroanterior normal chest radiograph after initiation of HAART and before onset of IRIS (A). Follow-up chest radiograph (B) obtained 14 days later shows a significant enlargement of paratracheal lymph nodes (arrows).
责任编辑：admin
上一篇：没有了
下一篇：医学文章阅读——CLINICAL UTILITY AND LIMITATIONS OF CHEST RADIOGRAPHY AND CT
微信公众号搜索“译员”关注我们，每天为您推送翻译理论和技巧，外语学习及翻译招聘信息。