Immune Reconstitution Inflammatory Syndrome (IRIS) Manifesting as Anogenital HSV-2 Infection in a HIV-1-Infected Patient After Initiation of Raltegravir

Abstract

Objective: To report a case of immune reconstitution inflammatory syndrome (IRIS), manifesting as anogenital HSV-2 infection after initiation of raltegravir-based antiretroviral (ARV) therapy. Case Summary: We report a case of a 30-year-old HIV-1-infected woman, who presented to an outpatient clinic to reinitiate HAART. Her CD4+ T cell count and HIV-1 RNA level were 100,000 copies/ml, respectively. Due to patient's previous inability to tolerate multiple HAART combinations, she was initiated on raltegravir and emtricitabine/tenofovir. The patient presented after one month of therapy with anogenital lesions that were subsequently diagnosed as HSV-2 infection based on culture results. Her CD4+ T-cell count at that time increased to 229 cells/mm (35%) and HIV-1 RNA level declined to 2,860 copies/ml. Discussion: Immune reconstitution inflammatory syndrome (IRIS) is a complication of highly active antiretroviral therapy (HAART) initiation, especially in patients with extremely low CD4+ T-cell counts and high HIV-1 RNA levels. It is suspected that this patient experienced IRIS, manifested by anogenital HSV-2 infection. This case represents the first published descriptive report of IRIS associated with raltegravir-based HAART. Conclusions: The strong temporal relationship that was seen in this case suggests the possibility of an association between the initiation of raltegravir and IRIS. Health care providers treating HIV-infected patients should consider this potential adverse reaction after initiation of raltegravir.