Clinical case definition and manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome

AIDS ◽  
2009 ◽  
Vol 23 (18) ◽  
pp. 2467-2471 ◽  
Author(s):  
Weerawat Manosuthi ◽  
Hong Van Tieu ◽  
Wiroj Mankatitham ◽  
Aroon Lueangniyomkul ◽  
Jintanat Ananworanich ◽  
...  
Keyword(s):  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Clinical Case ◽  
Case Definition ◽  
Inflammatory Syndrome ◽  
Clinical Case Definition

Validation of a published case definition for tuberculosis-associated immune reconstitution inflammatory syndrome

AIDS ◽  
2010 ◽  
Vol 24 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Lewis J Haddow ◽  
Mahomed-Yunus S Moosa ◽  
Philippa J Easterbrook
Keyword(s):  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Case Definition ◽  
Inflammatory Syndrome

Unmasking Lymphoma Immune Reconstitution Inflammatory Syndrome Among HIV-Infected Individuals In The Center For AIDS Research Network Of Integrated Clinical Systems

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4331-4331
Author(s):  
Satish Gopal ◽  
Monita Patel ◽  
Elizabeth Yanik ◽  
Greer Burkholder ◽  
Erin Reid ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Case Definition ◽  
Research Network ◽  
Hiv Rna ◽  
Art Initiation ◽  
Aids Research ◽  
Inflammatory Syndrome ◽  
Clinical Systems

Abstract Introduction Cohort studies have demonstrated increased incidence of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) among HIV-infected individuals during the first 6 months after antiretroviral therapy (ART) initiation, perhaps due to unmasking immune reconstitution inflammatory syndrome (IRIS). Unmasking IRIS is characterized by the diagnosis of a new HIV-associated condition soon after ART that was not apparent prior to ART, coupled with evidence of ART effectiveness. It has been well described for opportunistic infections and Kaposi sarcoma. However, clinical characteristics and survival for unmasking lymphoma IRIS have not been described. Methods We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) from 1996 until 2011. Unmasking lymphoma IRIS was defined as HL or NHL occurring within 6 months after ART initiation accompanied by a ≥0.5 log10copies/mL reduction in HIV RNA between values taken prior to ART and at lymphoma diagnosis. Differences in presentation and survival were examined between lymphoma IRIS and non-IRIS cases. Results Of 482 lymphoma patients, 48 (10%) met criteria for unmasking lymphoma IRIS. Of these, 10 (21%) had HL, 19 (40%) diffuse large B-cell lymphoma (DLBCL), 4 (8%) Burkitt lymphoma (BL), 9 (19%) primary central nervous system lymphoma (PCNSL), and 6 (12%) other NHL (Table). Median CD4 cell count at lymphoma diagnosis among IRIS cases was 163 cells/mL (interquartile range 67-302), and 54% had suppressed HIV RNA (< 400 copies/ml). No significant differences were identified between lymphoma IRIS and non-IRIS cases, with the exception of possible earlier stage (47% stage I/II versus 24%, p=0.03), more frequent hepatitis B/C co-infection (31% versus 19%, p=0.05), and more frequent prior AIDS illness (92% versus 79%, p=0.05), as well as expected lower HIV RNA at lymphoma diagnosis likely resulting from the IRIS case definition. Additionally, no differences in cumulative mortality 5 years after lymphoma diagnosis were identified between IRIS and non-IRIS cases, although there was a suggestion of increased early mortality among IRIS cases (Figure). Conclusions In a large HIV-associated lymphoma cohort in the United States, 10% of patients met a standardized unmasking lymphoma IRIS case definition. No major differences between lymphoma IRIS and non-IRIS cases were identified. Possible effects of subclinical lymphoma leading to care seeking behavior and subsequent ART initiation prior to lymphoma diagnosis could not be excluded. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions

2010 ◽  
Vol 10 (11) ◽  
pp. 791-802 ◽  
Author(s):  
Lewis J Haddow ◽  
Robert Colebunders ◽  
Graeme Meintjes ◽  
Stephen D Lawn ◽  
Julian H Elliott ◽  
...  
Keyword(s):  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Clinical Case ◽  
Case Definitions ◽  
Inflammatory Syndrome ◽  
Hiv 1

Clinical Markers of Immunodeficiency and Mechanism of Immune Reconstitution Inflammatory Syndrome and Highly Active Antiretroviral Therapy on HIV

2011 ◽  
Vol 23 (1) ◽  
pp. 165-171 ◽  
Author(s):  
V. Ramirez-Amador ◽  
W. Nittayananta ◽  
M. Magalhães ◽  
S.R. Flint ◽  
B.S. Peters ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Case Definition ◽  
Future Research ◽  
Oral Lesions ◽  
Clinical Markers ◽  
Highly Active ◽  
Inflammatory Syndrome

Antiretroviral therapy (ART) has improved survival and changed the disease pattern of HIV infection. However, ART may cause serious side effects, such as metabolic and cardiovascular complications. In addition, immune reconstitution inflammatory syndrome (IRIS) is being increasingly reported in relation to ART. The article presents the consensus of a workshop around 4 key issues: (1) the differences in the response of adults and children to highly active antiretroviral therapy, (2) the mechanism of the new HIV entry inhibitors and its effect on oral markers, (3) the pathogenesis of IRIS and the contradictory findings of the possible oral lesions related with IRIS, (4) and the benefits and barriers associated with using ART in the developing and developed world. The consensus of the workshop was that there is a need for future studies on the oral manifestations of HIV in individuals treated with new ARTs—especially, children. IRIS was considered a promising field for future research; as such, workshop attendees recommended formulating an IRIS–oral lesions case definition and following strict criteria for its diagnosis.

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