Immune reconstitution disease associated with parasitic infections following initiation of antiretroviral therapy

Abstract

Reports of immune reconstitution disease associated with parasitic infections are increasing, with many occurring in immigrants or migrants from areas where these diseases are endemic. The importance of such cases in antiretroviral therapy programmes in resource-limited settings, however, is not yet known.

Development of visceral leishmaniasis in an HIV+ patient upon immune reconstitution following the initiation of antiretroviral therapy

“…VL shortly after initiation of antiretroviral therapy has been reported before in the context of an immune reconstitution inflammatory syndrome (IRIS), which is defined as a hyperreactive immunologic response during the increase of peripheral CD4 + T-cell numbers upon treatment [10,11]. It is also observed in association with mycobacteriosis, cryptococcosis, or infection with JC-virus, Herpes-and Hepatitis-Virus [12].…”

Leishmaniasis mucocutánea en un paciente con infección por VIH: Case report

“…La forma mucocutánea suele relacionarse con estados de inmunosupresión (neoplasias, enfermedades crónicas) e infecciones virales como el VIH 6,7,17 . Nuestro paciente presentaba una infección por VIH ocho años antes de la presentación clínica, sin embargo, sus niveles de CD4 se mantuvieron constantes durante todo ese período, sin presentar criterios de síndrome de reconstitución inmune 25 . Además, el cuadro sintomatológico era leve por lo que en ese momento no ameritó terapia antirretroviral.…”

Neurologic Consequences of the Immune Reconstitution Inflammatory Syndrome (IRIS)

“…Cerebral edema associated with this infection can cause mass effects or even herniation in catastrophic cases. Leishmaniasis, caused by a protozoan transmitted by species of sandfly, has been reported in cutaneous and visceral presentations after cART initiation [39]. Because parasitic infections are more prevalent in resource-poor countries, the increasing global accessibility of cART should lead to an increased risk of parasite-associated CNS-IRIS.…”

“…Toxoplasma gondii, the causative organism of toxoplasmosis, being the major cause [39]. Cerebral toxoplasmosis can present with seizures, headaches, confusion, or focal motor findings.…”