What is it about?
Immune reconstitution inflammatory syndrome (IRIS) can occur after antiretroviral therapy is started, when recovering immune function produces an excessive inflammatory response to an underlying or previously unrecognised infection. We investigated the cytokine response associated with IRIS in South African patients by measuring ten cytokines simultaneously using Luminex multi-analyte profiling. The study included 17 confirmed IRIS cases and 17 HAART-duration-matched HIV-infected controls.
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Why is it important?
We found that interferon-gamma (IFN-γ) was significantly higher in patients with IRIS, with median concentrations of 9.88 pg/ml compared with 2.68 pg/ml in matched controls. IL-6 and IL-10 were also generally higher in IRIS, although these differences were not statistically significant. Within the IRIS group, IL-6, IL-10 and IFN-γ were significantly correlated, suggesting that the inflammatory response involves interactions between multiple cytokines rather than a single mediator. An interesting feature of the study was the heterogeneity between different forms of IRIS. Although increased IFN-γ and IL-6 were common, individual opportunistic infections showed distinct cytokine patterns. The small numbers within each clinical subgroup prevented formal statistical comparison, but the findings suggested that host-pathogen interactions may contribute to the different immunological manifestations of IRIS.
Perspectives
IRIS is a complex and dynamic inflammatory syndrome, and its pathogenesis is unlikely to be explained by a single cytokine. Our findings highlighted IFN-γ as a potential overall adjunctive marker of IRIS while also suggesting that additional cytokines may have value in understanding particular disease manifestations. The study also highlighted the importance of looking at immune responses longitudinally. Because immune reconstitution changes over time, larger studies with serial sampling and more detailed cellular analysis will be needed to determine how cytokine patterns evolve and which immune pathways drive different forms of IRIS.
Dr Catherine Worsley
University of Pretoria
Read the Original
This page is a summary of: Multi-analyte profiling of ten cytokines in South African HIV-infected patients with Immune Reconstitution Inflammatory Syndrome (IRIS), AIDS Research and Therapy, January 2010, Springer Science + Business Media,
DOI: 10.1186/1742-6405-7-36.
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