WASHINGTON, Sept 18 (Reuters) - Some AIDS patients whose
ravaged immune systems have been boosted by taking cocktails of
powerful medicines have been suffering a surprising increased
susceptibility to infections, researchers said on Monday.
Scientists at Thomas Jefferson University in Philadelphia
labeled as a medical paradox their discovery that AIDS patients
whose conditions had been improving thanks to treatment with
drug cocktails had been coming under attack from opportunistic
infections that ordinarily should not have been much of a
In a study published in the journal Annals of Internal
Medicine, the researchers said the sometimes-fatal "immune
reconstitution syndrome" stemmed from an inflammatory reaction
by the newly strengthened immune system to bacteria or viruses
already present in the patient.
The researchers said the causes of the syndrome were unknown.
The researchers said they were startled by the fact that the
infections were affecting patients who had been benefiting from
so-called highly active antiretroviral therapy (HAART)
involving the use of combinations of powerful anti-HIV (human
immunodeficiency virus) medicines.
The doctors described learning of patients with a typical
infection suffered by those with HIV -- mycobacterium avium
"The infection was not showing up in someone with end-stage
AIDS who wasn't taking antiretrovirals and HAART, but someone
getting better and on HAART," Thomas Jefferson University's Dr.
Joseph DeSimone said in a statement.
DeSimone said some doctors give antibiotics to treat the
opportunistic infections, while others prescribe
anti-inflammatory drugs. Some doctors reduce the HAART
"No one is exactly sure what to do against this syndrome yet,"
The study concluded that it would be difficult to form
controlled studies to find suppressing agents given the
"atypical and sporadic presentation of these reactions"
considering the number of patients using drug cocktails.
More than a year ago, researchers began to see patients with
HIV, the virus that causes AIDS, developing infections at times
that caught them off guard. The Jefferson doctors said they
decided to search the medical literature and speak with
colleagues to learn whether others had seen similar
They said doctors at other hospitals mentioned infections such
as CMV retinitis, an AIDS-related blindness.
"The AIDS-related blindness some patients experience was
getting better, and when patients were started on their HAART
therapy they overall were getting better," said Dr. Timothy
Babinchak, clinical director of infectious diseases at Thomas
Jefferson University Hospital.
"But then they seemed to be getting an aggravation of their
disease. It was another process, not necessarily the CMV being
reactivated. It was an inflammatory reaction to the CMV
infection already there."