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. Author manuscript; available in PMC: 2009 Nov 16.
Published in final edited form as: Curr Opin HIV AIDS. 2008 Jul;3(4):419–424. doi: 10.1097/COH.0b013e328302ebbb

Figure 1. The immunopathogenesis of immune reconstitution disease is not precisely known but there are indications that various players are involved.

Figure 1

CD4 T cells (1) are involved in mycobacterial and other granulomatous immune reconstitution disease (IRD) whereas CD8+ T cells (2) are more frequently associated with viral IRD. IRD could be the consequence of unbalanced reconstitution of overactivated T cells and regulatory T cells (Tregs) (3). Direct activation of monocytes (4) and dendritic cells (5) during immune reconstitution, in particular by living or dead mycobac-teria or antigenic debris could be a possibility (6). Antigen load (6) during immune restoration may be a determining factor as well. Finally, the cytokine environment (7) during immune restoration, IL-7 and IL-10 in particular, both important in T-cell homeostasis, could have a pivotal role in the IRD. MTB, Mycobacterium tuberculosis; Mϕ, macrophage.