Human immunodeficiency virus (HIV) in Washington, D.C.: Prevalence of antiretroviral resistance in treatment nave patients from 2007 to 2010

Swierzbinski, Matthew J.; Kan, Virginia L.; Parenti, David M.

doi:10.5897/jahr2015.0327

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…Still, this period is quite variable from case to case, typically from a few days to 6 months upon HAART initiation [1]. All patients performed repeated MRI, and all but one (our case) had histological studies (brain, in 4 cases; spinal medulla and muscle, in the other).…”

Section: Discussionmentioning

confidence: 99%

“…Immune reconstitution inflammatory syndrome (IRIS) occurs in a substantial proportion of patients with human immunodeficiency virus (HIV) infection during the first months of highly active antiretroviral therapy (HAART) [1]. IRIS can be associated to a concomitant autoimmune disorder, an immune-mediated inflammatory condition or, most frequently, an infectious disease.…”

Section: Introductionmentioning

confidence: 99%

“…IRIS can be associated to a concomitant autoimmune disorder, an immune-mediated inflammatory condition or, most frequently, an infectious disease. In the last case, IRIS is classified as unmasking or paradoxical, depending on the infection being subclinical/undiagnosed or previously diagnosed and treated, respectively [1, 2]. IRIS incidence varies depending on the underlying infection, reaching up to 40% in HIV-infected patients with cytomegalovirus retinitis [3].…”

Section: Introductionmentioning

confidence: 99%

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Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

et al. 2017

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BackgroundHIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed.Case presentationA 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4+ T cells and higher percentage of activated CD4+ T cells at HAART initiation. The percentage of memory CD4+ T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8+ T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset.ConclusionAlthough both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2159-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

et al. 2017

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“…Some have considered that PR may occur as a result of pre-existing allergies to medication [7]. Despite advances in our understanding of the immunological profile of patients who develop IRIS, such as recognition of the role of tumour necrosis factor α (TNF- α) and interleukin-6 [8] and other CD4 T-cell activation inflammatory cytokines and chemokines [9], and apart from introduction of ART in HIV-positive individuals, little is known regarding simple to measure baseline predictive factors for PR during anti-tuberculosis therapy [10]. There have been several, small case series from East Asia that have identified risk factors for developing PR.…”

Section: Introductionmentioning

confidence: 99%

Determinants of treatment-related paradoxical reactions during anti-tuberculosis therapy: a case control study

et al. 2016

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BackgroundInflammatory response following initial improvement with anti-tuberculosis (TB) treatment has been termed a paradoxical reaction (PR). HIV co-infection is a recognised risk, yet little is known about other predictors of PR, although some biochemical markers have appeared predictive. We report our findings in an ethnically diverse population of HIV-infected and uninfected adults.MethodsProspective and retrospective clinical and laboratory data were collected on TB patients seen between January 1999–December 2008 at four UK centres selected to represent a wide ethnic and socio-economic mix of TB patients. Data on ethnicity and HIV status were obtained for all individuals. The associations between other potential risk factors and PR were assessed in a nested case-control study. All PR cases were matched two-to-one to controls by calendar time and centre.ResultsOf 1817 TB patients, 82 (4.5 %, 95 % CI 3.6–5.5 %) were identified as having a PR event. The frequency of PR was 14.4 % (18/125; 95 % CI 8.2–20.6 %) and 3.8 % (64/1692; 2.9–4.7) for HIV-positive and HIV-negative individuals respectively. There were no differences observed in PR frequency according to ethnicity, although the site was more likely to be pulmonary in those of black and white ethnicity, and lymph node disease in those of Asian ethnicity. In multivariate analysis of the case-control cohort, HIV-positive patients had five times the odds of developing PR (aOR = 5.05; 95 % CI 1.28–19.85, p = 0.028), whilst other immunosuppression e.g. diabetes, significantly reduced the odds of PR (aOR = 0.01; 0.00–0.27, p = 0.002). Patients with positive TB culture had higher odds of developing PR (aOR = 6.87; 1.31–36.04, p = 0.045) compared to those with a negative culture or those in whom no material was sent for culture. Peripheral lymph node disease increased the odds of a PR over 60-fold 4(9.60–431.25, p < 0.001).ConclusionHIV was strongly associated with PR. The increased potential for PR in people with culture positive TB suggests that host mycobacterial burden might be relevant. The increased risk with TB lymphadenitis may in part arise from the visibility of clinical signs at this site. Non-HIV immunosuppression may have a protective effect. This study highlights the difficulties in predicting PR using routinely available demographic details, clinical symptoms or biochemical markers.

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HIV/Opportunistic Infections

Mokaya

Maurer

2017

Clinical and Basic Immunodermatology

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Human immunodeficiency virus (HIV) in Washington, D.C.: Prevalence of antiretroviral resistance in treatment nave patients from 2007 to 2010

Abstract: HIV treatment has been greatly impacted by transmitted resistance to antiretrovirals (ARV).

Cited by 9 publications

References 25 publications

Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

Determinants of treatment-related paradoxical reactions during anti-tuberculosis therapy: a case control study

HIV/Opportunistic Infections

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