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Author Topic: Immune Reconsitiution Syndrome  (Read 2422 times)

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Offline Etay1207

  • Member
  • Posts: 131
Immune Reconsitiution Syndrome
« on: August 08, 2010, 04:36:41 AM »
Could someone explain IRS/IRIS to me in a way that makes sense?
POZ since 1999
1/07 tcells: 530 vl: 72,922 7/07 tcells: 542 vl: 26,577
9/08 tcells: 339 vl: 56,120  7/09 tcells: 267 vl: 663,160
11/09 tcells: 71 vl: 498,670 2/10 tcells: 52 vl: 322,000
 no meds and feeling great!

Offline Grasshopper

  • Member
  • Posts: 451
Re: Immune Reconsitiution Syndrome
« Reply #1 on: August 08, 2010, 05:47:03 AM »
"When HIV-positive people with suppressed immune systems start potent ARV therapy, they might experience symptoms of diseases that have been silent, or latent, sometimes for years. This is called immune reconstitution inflammatory syndrome, or IRIS, and the symptoms that can crop up are actually caused by the rekindled immune system overreacting to the presence of infectious organisms rather than the underlying disease itself."

Offline Etay1207

  • Member
  • Posts: 131
Re: Immune Reconsitiution Syndrome
« Reply #2 on: August 08, 2010, 06:36:14 AM »
Isn't IRS symptoms of OI's that are present in most of the population but doesn't cause disease unless the immune system is damaged? i.e  Toxoplasma gondii, Pneumocystis jiroveci, Candida albacans, cytomegalovirus, Mycobacterium avium, and a host of other fungii, viruses, yeast, and bacteria.
POZ since 1999
1/07 tcells: 530 vl: 72,922 7/07 tcells: 542 vl: 26,577
9/08 tcells: 339 vl: 56,120  7/09 tcells: 267 vl: 663,160
11/09 tcells: 71 vl: 498,670 2/10 tcells: 52 vl: 322,000
 no meds and feeling great!

Offline mecch

  • Member
  • Posts: 11,224
  • red pill? or blue pill?
Re: Immune Reconsitiution Syndrome
« Reply #3 on: August 08, 2010, 07:00:05 AM »
Hmm etay.  That list of pathogens cause disease and especially for someone with a weak immune system.

Are you wondering about your own experience - why you are not sick, since you have a weakened immune system, and if you also assume you have exposure to some of these pathogens.  Are you wondering if you will get IRIS if you start HAART? 

I think this would be best answered by a doctor very experienced with initiation of HAART in people with very low CD4.

The thing is, with no HAART, a few of those pathogens will kill you. 

I guess the question is, do they suddenly "express" themselves because you start HAART, if they are latent now?  This seems answerable if you subjected yourself to myriad medical tests to see if these things are even present. How horribly time consuming and expensive that might be, and it wouldn't even be a good prediction of whether they would flare under HAART. 

And most doctors, I would guess, would just say the end game is take the HAART - and deal with the possible IRIS - which is hardly guaranteed.

Why don't you research the Lazarus Effect? 
There is a video about it on YouTube.
http://www.youtube.com/watch?v=l16YH6xCN4c

It's a good question, you ask, but maybe not the whole story or the right question.  It's time to look on the bright side of things, and time you started considering the true value of medical science.  I think this video above is very persuasive.

“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Etay1207

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  • Posts: 131
Re: Immune Reconsitiution Syndrome
« Reply #4 on: August 08, 2010, 08:43:45 AM »
Meech, I've seen the Lazarus Effect several times on YouTube. I'm not questioning whether or not I have these pathogens, because they infect up to 80% of the population. Chances are I have them. They only cause disease when someone's immune system has been weakened due to AIDS, chemotherapy, premature birth, drug use, old age. That's why they are call "opportunistic". A healthy person's immune system keeps the pathogen "in check" so to speak. Why is it different for someone who is HIV+? Why am I not sick because my immune system is "not working". 
POZ since 1999
1/07 tcells: 530 vl: 72,922 7/07 tcells: 542 vl: 26,577
9/08 tcells: 339 vl: 56,120  7/09 tcells: 267 vl: 663,160
11/09 tcells: 71 vl: 498,670 2/10 tcells: 52 vl: 322,000
 no meds and feeling great!

Offline Grasshopper

  • Member
  • Posts: 451
Re: Immune Reconsitiution Syndrome
« Reply #5 on: August 08, 2010, 08:46:11 AM »
Look at Concillia"s face at around 15:08 into the movie. I recognize the Molloscum in her face.
When I had it, my doc's called it IRIS. With lots of patience and daily cleansing with a prescription lotion it all cleared (took over a year), and I regained my clear complexion

Offline Hellraiser

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  • Posts: 4,136
  • Semi-misanthropic
Re: Immune Reconsitiution Syndrome
« Reply #6 on: August 08, 2010, 08:48:08 AM »
Meech, I've seen the Lazarus Effect several times on YouTube. I'm not questioning whether or not I have these pathogens, because they infect up to 80% of the population. Chances are I have them. They only cause disease when someone's immune system has been weakened due to AIDS, chemotherapy, premature birth, drug use, old age. That's why they are call "opportunistic". A healthy person's immune system keeps the pathogen "in check" so to speak. Why is it different for someone who is HIV+? Why am I not sick because my immune system is "not working". 

Your immune system will sometimes cause you to feel ill, as a result of doing its job.  In someone who has an immune system which is severely compromised your body is not fighting these infections.  Thus you feel fine while Rome is burning.  When you start taking meds your body starts building back up and it sometimes makes you feel sick, this is only temporary as after a couple of your months your body has beaten back these infections and reconstituted itself to the point that it can defeat these pathogens before they set up shop.

Offline Grasshopper

  • Member
  • Posts: 451
Re: Immune Reconsitiution Syndrome
« Reply #7 on: August 08, 2010, 08:51:51 AM »
Why am I not sick because my immune system is "not working". 

Don't even go there ! The above quoted question has NOTHING to do with your original question regarding IRIS.

(Don't say you were not warned, when this topic later evolves into a feeding frenzy)

Offline J.R.E.

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  • Posts: 7,095
  • Joined Dec-2003 Living positive, since 1985.
Re: Immune Reconsitiution Syndrome
« Reply #8 on: August 08, 2010, 09:51:27 AM »
This article explains it quite simply:

http://aids.about.com/od/otherconditions/a/immunerecon.htm




What is Immune Reconstitution Syndrome?
Rebuilding the Immune System Can Cause Problems

By Mark Cichocki, R.N., About.com Guide

Updated July 26, 2007


LZ had been diagnosed with a CMV infection in the right eye. After several days of treatment, the eye infection improved and LZ was discharged from the hospital. A week later during a follow-up appointment with his HIV specialist, LZ was started on HIV medications. And why not? His eye was healed, he felt much better, and the goal afterall is to control HIV replication preserving the immune system in the process.



After a couple weeks on his HIV regimen, LZ developed a fever, blurred vision, and swelling around his eye. The odd thing was that his CD4 count had gone up dramatically since starting HIV medications.

 So what was going on? His immune system was better, yet his eye looked horrible. LZ was seen by his doctor and was diagnosed with immune reconstitution syndrome. What is immune reconstitution syndrome? It sounds good so why did LZ have another severe eye infection? Let's take a look at this odd syndrome and try to make some sense out of it. The first step is to understand the immune system.

Know & Understand Your Immune System

Immune System Basics
The body has a built in defense mechanism that fights off infection and illness; the immune system. The body's immune system is comprised of several types of cells and processes that recognize and fight foreign invaders such as bacteria, parasites and viruses. Unfortunately, in people infected with HIV, the immune system is damaged, making it more difficult for the body to fight off these infections. How can we tell how healthy the immune system is? The answer is simple; by measuring the number of specialized immune system cells known as the CD4 cell. The higher the CD4 count the stronger the immune system.

Parts of the Immune System

What is a CD4 Count - Why is it Important?

How Do We Know the Immune System is Working?
When an infectious organism enters the body, a series of reactions occur that signal the immune system is working to fight off the infection. The reactions are collectively known as inflammation. Those inflammatory signs that the immune system is working include:

    * fever
    * swelling at the site of the injury or infection
    * redness of the site
    * thick drainage and discharge from the site of infection
    * warmth and pain at the site

In a damaged immune system some immune system functions may be absent.

What Is Immune Reconstitution?
Studies have shown that if HIV can be controlled by HIV medications, the immune system can repair itself. This immune rebuilding or reconstitution means that after repairing the damage done to the immune system, the body is better able to fight off those opportunistic infections that would otherwise make the person sick. As the HIV is controlled by medications, the body's CD4 count will rise, meaning the immune system is becoming stronger.

Opportunistic Infection Fact Sheets

What is Immune Reconstitution Syndrome?


Remember, if the body's immune system is damaged by HIV, the inflammatory process necessary for healing will not occur.

That inflammatory process will return as the immune system is reconstituted.

 Take our example of LZ and his eye infection. Antibiotic treatment killed off much of the infectious organism responsible for the eye infection. Because LZ's immune system was damaged, the was no inflammatory process present; no redness, swelling, etc.

When the HIV medications strengthened his immune system, the body sensed the remaining infectious organism in the eye, left behind after the antibiotic treatment was completed.

 Sensing the organisms, the newly reconstituted immune system triggered an inflammatory response, resulting in swelling, redness, discharge from the eye and fever.

While LZ's immune system was healthier, his eye infection returned. This is the irony of immune reconstitution syndrome.


Is Immune Reconstitution Serious?
While immune reconstitution syndrome signals a healthier immune system, it can be a serious, sometimes fatal condition. Depending on the infection present, aggressive treatment is necessary to prevent serious illness. Common infections that occur during immune reconstitution include

    * Pneumocystis Pneumonia
    * Herpes
    * CMV Infections
    * MAC Infections
    * Apthous Ulcers
    * Tuberculosis (TB)

What Can Be Done About Immune Reconstitution Syndrome?
Again, reconstituting the immune system is a good thing and while that process is desirable, the infection and inflammatory process present in immune reconstitution syndrome must be addressed. Treatment can include:

    * Continuation of the current HIV medication regimen.
    * Antibiotic or antiviral medications to treat the infection.
    * Steroids to temporarily suppress the inflammatory process.

Immune reconstitution syndrome is a complicated and confusing issue that has surfaced since the advent of HIV medications. If your doctor suggests you have reconstitution syndrome, ask a lot of questions and understand the syndrome and the plan of care completely before leaving his or her office.
« Last Edit: August 08, 2010, 09:53:46 AM by J.R.E. »
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline J.R.E.

  • Member
  • Posts: 7,095
  • Joined Dec-2003 Living positive, since 1985.
Re: Immune Reconsitiution Syndrome
« Reply #9 on: August 08, 2010, 10:05:46 AM »

Just wanted to add,  I went through Immune reconstitution after I started on meds.

I also had the eye infection going, as explained in the above article.  I also developed shingles again during this period of time.

Fortunately, it was a milder case of shingles, and the eye infection, which started about a week or two after starting on meds,  only lasted about a week.


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline littleprince

  • Member
  • Posts: 201
Re: Immune Reconsitiution Syndrome
« Reply #10 on: August 08, 2010, 02:09:11 PM »
Quote
Isn't IRS symptoms of OI's that are present in most of the population but doesn't cause disease unless the immune system is damaged? i.e  Toxoplasma gondii, Pneumocystis jiroveci, Candida albacans, cytomegalovirus, Mycobacterium avium, and a host of other fungii, viruses, yeast, and bacteria.

You're confusing the term OI. An OI is the infection caused by bacteria/fungus ect that are present in in every day life. The bacteria/fungus isn't itself an OI. So even though a person may have pneumocystis jiroveci (which causes the OI PCP) present in their lungs it doesn't mean that they have PCP. it's only if the pneumocystis jiroveci takes hold and starts an infection that it is called an OI.

IRS isn't a symptom of an OI. It's a totally different process that can occur when someones immune system starts recovering after they have had an OI. Basically, a persons immune system can be so weak/blind that it doesn't recognize a problem. only after HAART starts an the immune system gets stronger does it start to 'see' problems in the body. IRS is just your immune system coming late to the party and over reacting.

In the case of PCP, IRS is caused by the immune system waking up and 'seeing' all the dead pneumocystis jiroveci debris still laying around in your lungs. It thinks that there is an ongoing infection so starts to react.

Offline littleprince

  • Member
  • Posts: 201
Re: Immune Reconsitiution Syndrome
« Reply #11 on: August 08, 2010, 02:20:58 PM »
Quote
Why am I not sick because my immune system is "not working". 

Ok, I'll bite.

Your immune system IS working. It's just very weak. The lower your CD4 goes, the weaker it gets. The chance of getting an OI then starts to increase.

Using the PCP example from the earlier post, an immune system with CD4 of 50 is still able to fight off pneumocystis jiroveci. Just not very well. Eventually, the pneumocystis jiroveci will beat the immune system and then it very quickly downhill from there. It's just a matter of time. Pneumocystis jiroveci is constantly present and constantly trying to find a hole to get into your body. One day it will find the hole and sneak in. That what an OI is.

Offline mecch

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  • Posts: 11,224
  • red pill? or blue pill?
Re: Immune Reconsitiution Syndrome
« Reply #12 on: August 08, 2010, 04:12:23 PM »
Why is it different for someone who is HIV+? Why am I not sick because my immune system is "not working". 

JRE long post explains it perfectly.
In short, you are temporarily "not sick" but eventually either an OI will overwhelm your remaining immune system, and maybe kill you, or your immune system will be at 0 and you'll get multiple OI's and die. 
 
It's written in stone, ETAY.  You don't feel sick now but 3 decades of AIDS science reveals the facts.  Even your BF knows the facts.  You're going to get a nasty OI and it could spell your doom - you may not get the last minute reprieve you could have now.

Look on the bright side, since you know the video stories so well.  A lot of people with AIDS take HAART and they have a pretty smooth ride back to health.  IRIS seems to be rarely fatal.  AIDS aways is. Always.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline tednlou2

  • Member
  • Posts: 4,760
Re: Immune Reconsitiution Syndrome
« Reply #13 on: August 09, 2010, 02:39:45 AM »
Since we're having a refresher course, I had a question.  I've thought since being poz that I'm more susceptible to colds and flu.  However, I've read many Q&A's from Dr. Gallant and others who say HIVers are not any more prone to getting colds or flu than neg folks.  He said HIV does not make that cold or flu any more severe.  He said this is because colds and flu are not controlled by cell-mediated immunity.

Well, this is really good to know.  When I pass someone in a store who is coughing, I hold my breath until I pass them.  I'm always washing my hands to where I'm getting really dry skin.  I don't want a cold or flu anyway, but I thought we were more likely to catch it and for it to be more severe.  When I play with my dogs, I feel like I better wash my hands after. 

Why are other things more common in people with HIV?  I'm trying to think of things off the top of my head---things like aphthous ulcers and bacterial pneumonia, for example, are more common.  Shingles is somewhat more common in HIVers than the general public.  We've talked about eye infections and skin infections.  Is this because these things target different cells than colds and flu?

 




Offline Etay1207

  • Member
  • Posts: 131
Re: Immune Reconsitiution Syndrome
« Reply #14 on: August 09, 2010, 07:07:45 AM »
Tednlou, good question!
POZ since 1999
1/07 tcells: 530 vl: 72,922 7/07 tcells: 542 vl: 26,577
9/08 tcells: 339 vl: 56,120  7/09 tcells: 267 vl: 663,160
11/09 tcells: 71 vl: 498,670 2/10 tcells: 52 vl: 322,000
 no meds and feeling great!

Offline mecch

  • Member
  • Posts: 11,224
  • red pill? or blue pill?
Re: Immune Reconsitiution Syndrome
« Reply #15 on: August 09, 2010, 07:54:08 AM »
So, Etay, don't skirt the question.
What situation might change your mind and cause you to start HAART?
An OI?  Are you afraid of IRIS - or just asking out of some objective curiousity?

Do you believe you are truly healthy now?  Or do you believe the medical theory that you have conditions you could be fighting but your immune system can't muster the strength?  

That's a pretty good question too.  Kind of metaphysical but I know you are up to the task of answering it.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline J.R.E.

  • Member
  • Posts: 7,095
  • Joined Dec-2003 Living positive, since 1985.
Re: Immune Reconsitiution Syndrome
« Reply #16 on: August 09, 2010, 08:36:21 AM »

Well, this is really good to know.  When I pass someone in a store who is coughing, I hold my breath until I pass them.  I'm always washing my hands to where I'm getting really dry skin. 




Just get one of these.  It will keep sick people away from you !   :)


http://www.youtube.com/watch?v=E7FhpRMc2n0


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

 


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