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

Stoll, Matthias; Schmidt, Reinhold

doi:10.1007/s11904-004-0018-7

Cited by 34 publications

(16 citation statements)

References 50 publications

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“…63,64 Other risk factors include the duration and extent of immunodeficiency, polymorphisms in cytokine genes, 65 high initial viral load, and the velocity of immune reconstitution. 66 No difference in the risk of developing IRIS has been observed when comparing different drug regimens. 63 However, initiation of HAART soon after the diagnosis of opportunistic infection may be a clinical predictor of IRIS.…”

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

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“…Other risk factors include duration and extent of immunodeficiency, genetic susceptibility factors, and velocity of immune reconstitution (Stoll & Schmidt, 2004). This is particularly important as antiretroviral therapy is becoming available to large numbers of people worldwide.…”

Section: Can Immune Reconstitution Syndrome In Cns With Haart Mimic Hmentioning

confidence: 99%

Evolution of HIV dementia with HIV infection

Nath

Schiess

Venkatesan

et al. 2008

International Review of Psychiatry

114

111

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Dementia remains one of the most fearsome complications of HIV infection. It also poses a significant challenge for the clinician both in terms of diagnosis and treatment. The use of antiretroviral agents has led to a decrease in the incidence of HIV dementia but the prevalence of milder forms of neurocognitive impairment has increased. Occasionally, the immune reconstitution caused by these agents may target the brain leading to a syndrome characterized by a severe, progressive and often fatal dementia. The progression of HIV dementia may also be determined by host and viral genetic factors, and the existence of co-morbid factors such as drug abuse, hepatitis C infection and aging. Oxidative stress markers appear to be predictive of active dementia. However, currently there is no specific treatment available for HIV dementia.

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“…Die Therapieoptionen des manifesten IRIS bei HIV-positiven und bei HIV-negativen Patienten beinhalten Glukokortikoide, nichtsteroidale antiinflammatorische Medikamente, intravenöse Immunglobuline, Hydroxychloroquin und Biologika, wobei prospektive kontrollierte Studien für die meisten Medikamente fehlen [13,48,51,120,121,122]. Eine kontrollierte Studie konnte einen Vorteil für den Einsatz von Kortikosteroiden beim pulmonalen Tbc-assoziierten IRIS bei HIV-Patienten zeigen [123].…”

Section: » Glukokortikoide Werden Bei Schweren Iris-fällen Als Antiinunclassified

Immunrekonstitutionssyndrome

Ernst

Stoll

2012

Z. Rheumatol.

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The immune reconstitution inflammatory syndrome (IRIS) represents a heterogeneous group of conditions. Whilst they typically present in HIV-infected patients with advanced immunodeficiency, IRIS have also been described in HIV-negative patients with immune reconstitution due to other causes of immunosuppression. Frequently IRIS results from an immune response against underlying infection (pathogen-associated IRIS). However, IRIS might become evident during immune reconstitution without an underlying pathogen such as a sarcoid-like illness or an autoimmune thyropathy. Here we report on the epidemiology and risk factors of IRIS along with diagnosis and management of this clinically important inflammatory syndrome.

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

Cited by 34 publications

References 50 publications

JC Virus Infection of the Brain

JC Virus Infection of the Brain

Evolution of HIV dementia with HIV infection

Immunrekonstitutionssyndrome

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