Human immunodeficiency virus-associated polymyositis during immune restoration with combination antiretroviral therapy

Sellier, Pierre; Monsuez, Jean‐Jacques; Evans, John J.; Minozzi, C.; Passeron, Jean Claude; Vittecoq, D.; Dussaix, Élisabeth; Carcelain, G.; Lacroix-Jousselin, Catherine

doi:10.1016/s0002-9343(00)00562-3

Cited by 33 publications

(12 citation statements)

References 4 publications

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“…High pathogen load Immune dysregulation first few months therapy [131][132][133][134]. A patient with relapsing polychondritis and sarcoidosis presented after 2 years [126].…”

Section: Cd4 T-cells ͻ50/µlmentioning

confidence: 99%

Immune restoration disease after antiretroviral therapy

French

Price

Stone

2004

AIDS

573

473

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Suppression of HIV replication by highly active antiretroviral therapy (HAART) often restores protective pathogen-specific immune responses, but in some patients the restored immune response is immunopathological and causes disease [immune restoration disease (IRD)]. Infections by mycobacteria, cryptococci, herpesviruses, hepatitis B and C virus, and JC virus are the most common pathogens associated with infectious IRD. Sarcoid IRD and autoimmune IRD occur less commonly. Infectious IRD presenting during the first 3 months of therapy appears to reflect an immune response against an active (often quiescent) infection by opportunistic pathogens whereas late IRD may result from an immune response against the antigens of non-viable pathogens. Data on the immunopathogenesis of IRD is limited but it suggests that immunopathogenic mechanisms are determined by the pathogen. For example, mycobacterial IRD is associated with delayed-type hypersensitivity responses to mycobacterial antigens whereas there is evidence of a CD8 T-cell response in herpesvirus IRD. Furthermore, the association of different cytokine gene polymorphisms with mycobacterial or herpesvirus IRD provides evidence of different pathogenic mechanisms as well as indicating a genetic susceptibility to IRD. Differentiation of IRD from an opportunistic infection is important because IRD indicates a successful, albeit undesirable, effect of HAART. It is also important to differentiate IRD from drug toxicity to avoid unnecessary cessation of HAART. The management of IRD often requires the use of anti-microbial and/or anti-inflammatory therapy. Investigation of strategies to prevent IRD is a priority, particularly in developing countries, and requires the development of risk assessment methods and diagnostic criteria.

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“…High pathogen load Immune dysregulation first few months therapy [131][132][133][134]. A patient with relapsing polychondritis and sarcoidosis presented after 2 years [126].…”

Section: Cd4 T-cells ͻ50/µlmentioning

confidence: 99%

Immune restoration disease after antiretroviral therapy

French

Price

Stone

2004

AIDS

573

473

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“…Descriptions include cases of autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, polymyositis, autoimmune thyreopathy, alopecia, allergic reaction (eg, against pre-existing tattoos), disease of unknown etiology, such as sarcoidosis, development of factor VIII inhibitor, and the induction of atherogenic chronic inflammation [36][37][38][39][40][41][42][43][44][45][46].…”

Section: Noninfectious Diseasementioning

confidence: 99%

Immune restoration inflammatory syndromes: Apparently paradoxical clinical events after the initiation of HAART

Stoll

Schmidt²

2004

Curr HIV/AIDS Rep

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Immune reconstitution occurs after initiation of highly active antiretroviral therapy in immunodeficient HIV-positive individuals. Unexpected deterioration of inflammatory disease and atypical clinical features resembling symptoms of autoimmune disease may arise. These atypical inflammatory disorders, synonymously summarized as immune reconstitution syndrome, immune restoration disease, and immune restoration inflammatory syndrome (IRIS), are caused by augmentation of inflammation during immune reconstitution in an immunocompromised host. These disorders have to be distinguished from intercurrent infection and rheumatic disease, respectively. Treatment of IRIS consists of elements for both potential differential diagnoses (ie, anti-inflammatory and immunosuppressive drugs, such as in autoimmune disorders and antimicrobial chemotherapy, to decrease the burden of pathogen, such as in infectious disease). Therefore, awareness for IRIS is of increasing importance from a clinical point of view. However, diagnostic criteria and standards of treatment are still preliminary.

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“…These include cases of systemic lupus erythematosus [50], rheumatoid arthritis [51], polymyositis [52], autoimmune thyropathy [53], alopecia universalis [54], and sarcoidosis [55]. Further cases include Pneumocystis carinii infection [56,57], cryptococcosis [58], leishmaniasis, mikrosporidiosis [59], warts [2••,60], appendicitis, cholecystitis, and splenitis [61].…”

Section: Further Events Of Immune Restoration Inflammatory Syndromementioning

confidence: 99%

Immune restoration inflammatory syndromes: The dark side of successful antiretroviral treatment

Stoll

Schmidt²

2003

Curr Infect Dis Rep

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The prevalence of cellular immunodeficiency has increased due to rising use of immunosuppressive therapies and the pandemic spread of HIV infection. More recently, the introduction of highly active antiretroviral therapy (HAART) in HIV has led to significant immune reconstitution, even in patients with previously long-lasting secondary immunodeficiency. HAART reduces morbidity and mortality in HIV infection and also changes the clinical course of prevalent subclinical opportunistic infections or autoimmune diseases. Atypical inflammatory disorders develop after initiation of HAART and have been summarized as "immune reconstitution syndrome," "immune restoration disease," and "immune restoration inflammatory syndrome." However, diagnostic criteria and standards of therapy are yet to be defined. The awareness for these diseases is of increasing importance from a clinical point of view. This review summarizes the variety of immunoreconstitution disorders and describes possible diagnostic pitfalls. We also propose possible therapeutic options.

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Human immunodeficiency virus-associated polymyositis during immune restoration with combination antiretroviral therapy

Cited by 33 publications

References 4 publications

Immune restoration disease after antiretroviral therapy

Immune restoration disease after antiretroviral therapy

Immune restoration inflammatory syndromes: Apparently paradoxical clinical events after the initiation of HAART

Immune restoration inflammatory syndromes: The dark side of successful antiretroviral treatment

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