Immune reconstitution inflammatory syndrome: more answers, more questions

Shelburne, Samuel A.; Montes, Martín; Hamill, Richard J.

doi:10.1093/jac/dki444

Cited by 251 publications

(201 citation statements)

References 31 publications

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“…The diagnosis is often challenging, treatment options are limited, and the prognosis is variable. 61 The diagnosis of IRIS is advocated when a patient meets the following criteria 62 : known HIV-positive patient receiving HAART with a decrease in the HIV-1 ribonucleic acid level from baseline and an increase in CD4ϩ cells from baseline with clinical symptoms consistent with an inflammatory process rather than an expected course of previously diagnosed opportunistic infection or the expected course of newly diagnosed opportunistic infection or drug toxicity. In the CNS context, the disease may be called NIRIS.…”

Section: Iris and Nirismentioning

confidence: 99%

JC Virus Infection of the Brain

Bag¹,

Curé²,

Chapman³

et al. 2010

AJNR Am J Neuroradiol

118

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SUMMARY:Since its initial description, there have been significant changes in the epidemiology, pathogenesis, and clinical and imaging manifestations of JCV infection of brain. The most common clinical manifestation is PML. Other recently described CNS manifestations are JCE, JCVGCN, and JCM. Although AIDS is the most common predisposing factor for JCV reactivation, there is increasing incidence of brain manifestations of JCV reactivation in non-HIV settings, including different rheumatologic, hematologic, and oncologic conditions; monoclonal antibody therapy; transplant recipients; primary immunodeficiency syndromes; and even in patients without any recognizable immune deficiency. IRIS may develop secondary to restoration of immunity in HIV-positive patients with PML receiving antiretroviral therapy. This is of profound clinical significance and needs to be diagnosed promptly. Imaging plays a crucial role in the diagnosis of the disease, monitoring of treatment response, identifying disease progression, and predicting prognosis. In this article, current understanding of the epidemiology, pathogenesis, clinical presentations, and all aspects of imaging of JCV infection of the brain have been comprehensively reviewed.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; CNS ϭ central nervous system; cPML ϭ classic PML; Cr ϭ creatine; CTL ϭ cytotoxic T-lymphocytes; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; HAART ϭ highly active antiretroviral therapy; HIV ϭ human immunodeficiency virus; ICL ϭ idiopathic CD4 lymphocytopenia; iPML ϭ inflammatory PML; IRIS ϭ immune reconstitution inflammatory syndrome; JCE ϭ JCV encephalopathy; JCM ϭ JCV meningitis; JCV ϭ JC virus; JCVGCN ϭ JCV granular cell neuronopathy; mAb ϭ monoclonal antibody; mIns ϭ myo-inositol; MS ϭ multiple sclerosis; MTR ϭ magnetization transfer ratio; NAA ϭ N-acetylaspartate; NIRIS ϭ neuro-IRIS; PCR ϭ polymerase chain reaction; PML ϭ progressive multifocal leukoencephalopathy; PML-IRIS ϭ PML associated with IRIS; RR ϭregulatory region; SLE ϭ systemic lupus erythematosus

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Section: Iris and Nirismentioning

confidence: 99%

JC Virus Infection of the Brain

Bag¹,

Curé²,

Chapman³

et al. 2010

AJNR Am J Neuroradiol

118

View full text Add to dashboard Cite

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“…24 Unreliable diagnosis of TB, both latent and active, in HIV-infected individuals constitutes a special consideration for early ART initiation in countries with high endemic TB rates and moderate to high HIV burdens. Failure to treat latent TB infections can mean that ART treatment, via reconstitution, or the reversal of HIV-related immune system decline, makes it possible to transmit TB to others.…”

Section: Inflammatory Syndrome (Iris)mentioning

confidence: 99%

Early initiation of antiretroviral therapy and universal HIV testing in sub-Saharan Africa: Has WHO offered a milestone for HIV prevention?

Menon¹

2010

J Public Health Pol

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The majority of new HIV infections occur in sub-Saharan Africa and other developing countries with scarce financial resources and meagre health system infrastructure. Expansion of Antiretroviral Therapy (ART) may overwhelm health services capacity, result in suboptimal care, and divert attention from crucial preventive measures. A 2009 WHO guideline recommends earlier initiation of ART for adults and adolescents, treatment at CD4 counts of 350 cells/mm 3 along with universal testing. For sub-Saharan Africa, WHO previously recommended a threshold of 200 cells/mm 3 . Despite vast potential benefits of early ART initiation at individual and community levels, it does not necessary follow that clinical experience in industrialised countries can be replicated in resource-limited settings with moderate to high HIV burdens. Adherence to the 2009 WHO guidelines is unlikely to be sustainable without guarantees of adequate national and donor support -something all developing countries need to consider before adoption of the new policy.

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“…Predictors of IRIS are few, but it appears that a low CD4 nadir, CD4 T cell increase after one month of therapy, rate of decrease in HIV RNA levels, CD8 T cell numbers and previous opportunistic infections all may play a role [46,[53][54][55]. Although the antigen driving IRIS is speculated to be mycobacterial or fungal, HIV or other ubiquitous viral antigens have not entirely been excluded as a cause of IRIS.…”

Section: Clinical Implications Of Haart On Pulmonary Disease In Hiv Imentioning

confidence: 99%

“…Although much is known regarding T cell subset redistribution in the blood during HAART, very little is known regarding the role of different T cell subsets in IRIS or local lung T cells during an IRIS episode [55]. Immunologically, both CD8 and CD4 T cells have been implicated in IRIS and vary depending on the site of IRIS.…”

Section: Clinical Implications Of Haart On Pulmonary Disease In Hiv Imentioning

confidence: 99%

HIV-related lung disorders

Twigg

Knox

2007

Drug Discovery Today: Disease Mechanisms

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Highly active antiretroviral therapy (HAART) has dramatically altered the spectrum of morbidity and mortality in HIV-infected patients. This has been attributed to improvements in the lung microenvironment leading to enhanced pulmonary immunity, either by preventing the progressive loss of immune function or by actually promoting immune restoration. However, these changes have been accompanied by the recognition of new pulmonary complications in HIV-infected subjects, especially those associated with immune reconstitution. In this review we will describe how HIV infection alters the normal pulmonary environment, highlight the effect of HAART on these perturbations, and discuss potential complications of HAART in the lung, focusing on the pulmonary immune reconstitution inflammatory syndrome.

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Immune reconstitution inflammatory syndrome: more answers, more questions

Cited by 251 publications

References 31 publications

JC Virus Infection of the Brain

JC Virus Infection of the Brain

Early initiation of antiretroviral therapy and universal HIV testing in sub-Saharan Africa: Has WHO offered a milestone for HIV prevention?

HIV-related lung disorders

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