Immune reconstitution inflammatory syndrome in HIV infection. Differential diagnostics and treatment issues

Patients with human immunodeficiency virus infection who have started antiretroviral therapy at advanced stages of the disease often develop immune reconstitution inflammatory syndrome. This process is associated with activation of the immune response, which can lead to uncontrolled inflammatory responses and, in some cases, the development of neoplastic diseases such as Kaposi’s sarcoma and non-Hodgkin’s lymphomas. In addition, lymphadenopathy that occurs within the framework of immune reconstitution inflammatory syndrome during cancer remission can be mistakenly interpreted as a relapse of a malignant tumor, which is an objective diagnostic complexity, especially given the possibility of the appearance of viral mutations that can reduce the effectiveness of the initial regimen and require treatment correction. In addition, patients with human immunodeficiency virus and developed immune reconstitution inflammatory syndrome may develop CNS lymphomas and cross-symptoms. The appearance of these complications against the background of immune reconstitution inflammatory syndrome requires careful differential diagnosis, since signs that can be interpreted as relapse of lymphoma can be caused precisely by inflammatory reactions or neurological symptoms associated with the reconstitution of the immune system. In this article, using the example of a clinical case and an analysis of the literature, we presented how immunological and virological changes caused by human immunodeficiency virus and antiretroviral therapy switching in a patient with lymphoma can lead to erroneous conclusions (relapse of lymphoma, development of an opportunistic infection), when only a detailed analysis of clinical, laboratory and instrumental data with the involvement of a multidisciplinary team of doctors allowed differential diagnosis of inflammatory and tumor processes associated with immune reconstitution inflammatory syndrome. It is important to note that dynamic monitoring of the viral load, instrumental control of the manifestations of the oncological process make it possible to correctly interpret possible changes and make the right clinical decisions.

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