Clinical spectrum of the immune restoration inflammatory syndrome

Battegay, Manuel; Drechsler, Henning

doi:10.1097/01.coh.0000194362.59762.24

Cited by 11 publications

(7 citation statements)

References 66 publications

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“…The median duration of immune reconstitution was 17 months. [16][17][18] Patients with lower CD4 counts at baseline, who experienced greater increments in the CD4 counts following HAART, were more likely to develop AITD. But none of the patients in our study was found to have immune reconstitution syndrome.…”

Section: Discussionmentioning

confidence: 99%

A study of thyroid dysfunction in HIV infected patients in a tertiary care hospital

Kaneria

Kahalekar

2016

Int J Adv Med

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Section: Discussionmentioning

confidence: 99%

A study of thyroid dysfunction in HIV infected patients in a tertiary care hospital

Kaneria

Kahalekar

2016

Int J Adv Med

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“…In persons with HIV infection, Graves' disease may occur after immune reconstitution from HAART. However, unlike classic immune reconstitution inflammatory syndrome caused by mycobacteria and other pathogens, which develops during the first 3 months of HAART [42,43], Graves' disease is most commonly diagnosed 12-36 months after HAART initiation. The difference in timing may be explained by differences in the type of CD4 cell count that increases during these 2 periods.…”

Section: Increased Thyroid Functionmentioning

confidence: 99%

Thyroid Function Abnormalities in HIV-Infected Patients

Hoffmann

Brown

2007

Clinical Infectious Diseases

100

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Abnormal thyroid function test results are common among human immunodeficiency virus (HIV)-infected patients. Although the prevalence of overt thyroid disease does not appear to be significantly increased in HIV-infected patients, compared with the general population, specific patterns of abnormal thyroid function test findings are more frequently identified among HIV-infected patients. Among patients with advanced acquired immunodeficiency syndrome, nonthyroidal illness (i.e., euthyroid sick syndrome) is common. During antiretroviral therapy, the prevalence of 2 generally asymptomatic conditions (subclinical hypothyroidism, which is characterized by isolated elevated thyroid-stimulating hormone levels, and isolated low free thyroxine levels) is increased. In addition, Graves disease, which is marked by low thyroid-stimulating hormone and elevated thyroxine levels, may occur during immune reconstitution. Testing for thyroid disease among symptomatic patients should begin with measurement of the thyroid-stimulating hormone level. However, there is insufficient evidence to recommend routine thyroid screening of asymptomatic HIV-infected individuals. This review summarizes the current evidence regarding the optimal laboratory evaluation of thyroid function; highlights the causes, presentation, and treatment of thyroid dysfunction in HIV-infected patients; and discusses the controversies regarding screening.

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“…Clinical worsening of infectious syndromes after initiation of ART, or immune reconstitution inflammatory syndrome (IRIS), has been extensively described in the HIV literature. 7 In these patients, initiating ART elicits a pathological inflammatory response to either a previously treated infection or a subclinical infection. IRIS has also been described in patients with MS in the setting of cessation of immunosuppressive medications, often with concurrent PML.…”

Section: Discussionmentioning

confidence: 99%

Multiple sclerosis and HIV: a case of multiple sclerosis-immune reconstitution inflammatory syndrome associated with antiretroviral therapy initiation

Anand

Saylor

2018

Int J STD AIDS

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Studies have suggested that the incidence of multiple sclerosis (MS) in HIV-infected (HIV+) patients is lower than that of the general population. Here, we present a case of MS in an HIV+ patient with a relatively suppressed CD4 cell count who developed clinical and radiographic disease worsening in the setting of antiretroviral therapy (ART) initiation. A 47-year-old HIV+ woman (CD4 cell count 216 cells/µl) presented with decreased vision in her right eye. Magnetic resonance imaging (MRI) revealed optic nerve enhancement and open ring-enhancing lesions in the brain concerning for demyelinating disease. Cerebrospinal fluid was tested extensively for infection and malignancy with no abnormal findings. She received five days of intravenous methylprednisolone. Nine days later, she was restarted on ART. Three weeks later, she was readmitted with left eye vision loss and left hemiplegia (CD4 cell count 342 cells/µl). Repeat imaging showed multiple new enhancing lesions. Several cases have described severe MS relapses and unusually widespread demyelinating lesions on MRI after withdrawal of immunosuppressive drugs. We posit that the clinical and radiographic progression that occurred in our patient after initiation of ART represented an immune reconstitution response to ART. Caution may be warranted when initiating ART in HIV+ patients with suppressed CD4 cell count and active MS.

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Clinical spectrum of the immune restoration inflammatory syndrome

Cited by 11 publications

References 66 publications

A study of thyroid dysfunction in HIV infected patients in a tertiary care hospital

A study of thyroid dysfunction in HIV infected patients in a tertiary care hospital

Thyroid Function Abnormalities in HIV-Infected Patients

Multiple sclerosis and HIV: a case of multiple sclerosis-immune reconstitution inflammatory syndrome associated with antiretroviral therapy initiation

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