Highly active anti-retroviral therapy (HAART) reduces HIV infection mortality and morbidity, modifying natural history of opportunistic and auto-immune diseases. However, in 10 to 25% of patients, the immune system restoration will provoke severe reaction against co-existent infections, causing diseases, by opportunistic agents, with atypical features, and intense tissue inflammation. All clinical and laboratorial changes resulting from this increased inflammatory response are called immune reconstitution inflammatory syndrome (IRIS). Paradoxical clinic worsening of a known disease or appearance of a new one, after beginning of HAART, characterize this syndrome. Potential mechanisms include partial immune reconstitution or host increased immune response to the antigenic stimulus. There are two main forms: an earlier that arises up to the third month after HAART, due to immune reaction against opportunistic agents that remained in a sub-clinic disease; and other later that emerges after months or years as an immune reaction evolution against opportunistic agents whose manifestations were unexpected. This syndrome occurs mainly in those with less than 50/mm³ T CD4 and very high HIV viral load before HAART, as so non-detected antigens from micro-organisms whose clinical manifestations were unexpected. Most diseases are dermatological, mainly, genital herpes and warts. However, among those infected with Mycobacterium tuberculosis, Mycobacterium avium complex or Cryptococcus neoformans, the syndrome affects up to 45% of patients. For the sake of the Proctologist, we could mention cases of herpes simplex, herpes zoster, contagious moluscus, condylomata acuminata, Kaposi´s sarcoma, bowel obstruction due to disseminated hystoplasmosis and ulcerative colitis by CMV, causing enteric perforation. Interaction among medical staffs should identify the syndrome and define the best treatment for each patient, avoiding undesirable evolutions.
Immune reconstitution inflammatory syndrome; AIDS serodiagnosis; Papillomavirus infections; Herpes simplex