scholarly journals IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME IN HIV INFECTION

2018 ◽  
Vol 8 (2) ◽  
pp. 139-149 ◽  
Author(s):  
E. V. Boeva ◽  
N. A. Belyakov
Keyword(s):  
Risk Factors ◽  
Hiv Infection ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Opportunistic Infections ◽  
Clinical Manifestations ◽  
Antiretroviral Drugs ◽  
People Living With Hiv ◽  
Hiv Rna ◽  
Inflammatory Syndrome

Antiretroviral therapy (ART) leads to suppression of HIV replication, contributes to increase in the number of CD4-lymphocytes count and  partial restoration or activation of the immune system. The  consequence is a reduction of incidence of opportunistic diseases,  increase in the duration and quality of life of people living with HIV  (PLHIV). However, in some patients with severe immunosuppression, this may be accompanied by a worsening of the condition and risks  of formation of the immune reconstitution inflammatory syndrome  (IRIS), which manifests itself in the development of new or  previously treated opportunistic, secondary and exacerbating non- infectious diseases against a virologically effective ART. The  frequency of the development of IRIS varies widely, in cases of  tuberculosis-associated manifestation it can reach 50%. Risk factors  for the development of IRIS are low initial CD4-lymphocyte count  and a high load of HIV RNA in the blood, the presence of  opportunistic infections during the initiation of ART. Discussed terminology issues, other possible risk factors for the  development of the syndrome, regularities of the pathological process are considered. Epidemiological statistics of  IRIS, pathogenetic bases, variants of clinical and laboratory  manifestations of complications are given. The criteria for diagnosis  of the syndrome, as well as the necessary conditions for its  occurrence, are considered. Particular attention is paid to the most  common opportunistic infections that cause the manifestation of  IRIS, the peculiarities and polymorphism of clinical manifestations  and the prevention of their occurrence. Currently, there is an  increasing incidence of HIV infection in the late stages. Laboratory  and clinical differences in the manifestations of acquired  immunodeficiency syndrome (AIDS) and IRIS have been sanctified. In view of the blurring of the diagnostic criteria, in the  Russian Federation specialists rarely expose IRIS to clinical or pathological diagnoses, therefore it is rather difficult to trace the  frequency of occurrence of this condition. Clinical and laboratory  manifestations are systematized, which allows to formulate this  diagnosis on the basis of their totality. Prevention of IRIS is the  prudent prescription of antiretroviral drugs. It is neces sary to  conduct a qualitative and timely diagnosis of concomitant diseases of infectious and non-infectious nature before the initiation of ART and  during treatment, the appointment of effective etiotropic therapy for  opportunistic and secon dary infections. In order to improve the  prognosis of HIV infection, preferably early onset of ART with stable  CD4-lym phocyte counts and low HIV RNA levels in the blood.

scholarly journals Hemophagocytic Syndrome Associated with Immune Reconstitution Inflammatory Syndrome in a Patient with AIDS Related Burkitt’s Leukemia/Lymphoma

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Metin Kanıtez ◽  
Mahir Kapmaz ◽  
Nilufer Alpay ◽  
Fatih Selcukbiricik ◽  
Atahan Çağatay ◽  
...  
Keyword(s):  
Immune Function ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Hemophagocytic Syndrome ◽  
Opportunistic Infections ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
High Dose ◽  
Inflammatory Syndrome

Highly active antiretroviral therapy (HAART) has markedly decreased human immunodeficiency virus- (HIV-) related mortality and the incidence of opportunistic infections. The dramatic reduction in HIV-1 RNA and increase in CD4 lymphocyte count mean a recovery in immune function. This restoration in immune function may be associated with paradoxical deterioration in subclinical opportunistic infections in some patients, a condition called immune reconstitution inflammatory syndrome (IRIS). IRIS, a “paradoxical” inflammatory response to either previously treated or subclinical infections or noninfectious diseases, can manifest during the restoration phase of immunity hemophagocytic syndrome (HS) which is a very rare complication in patients with acquired immune deficiency syndrome (AIDS). We describe a case of hemophagocytic syndrome associated with IRIS in a patient with AIDS related Burkitt’s leukemia/lymphoma (BL). IRIS was probably the cause of hemophagocytosis for our patient. Zoster infection may facilitate to IRIS. With the increasing number of people with HIV infection and the accompanying use of HAART, much more clinical manifestations of IRIS will be experienced especially in patients given high dose chemotherapy, just like in our case.

scholarly journals Systemic Inflammation Associated with Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV

Life ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 65
Author(s):  
Caian L. Vinhaes ◽  
Mariana Araujo-Pereira ◽  
Rafael Tibúrcio ◽  
Juan M. Cubillos-Angulo ◽  
Fernanda O. Demitto ◽  
...  
Keyword(s):  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Opportunistic Infections ◽  
Inflammatory Responses ◽  
Morbidity And Mortality ◽  
People Living With Hiv ◽  
Art Initiation ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Antiretroviral therapy (ART) has represented a major advancement in the care of people living with HIV (PLWHH), resulting in significant reductions in morbidity and mortality through immune reconstitution and attenuation of homeostatic disruption. Importantly, restoration of immune function in PLWH with opportunistic infections occasionally leads to an intense and uncontrolled cytokine storm following ART initiation known as immune reconstitution inflammatory syndrome (IRIS). IRIS occurrence is associated with the severe and rapid clinical deterioration that results in significant morbidity and mortality. Here, we detail the determinants underlying IRIS development in PLWH, compiling the available knowledge in the field to highlight details of the inflammatory responses in IRIS associated with the most commonly reported opportunistic pathogens. This review also highlights gaps in the understanding of IRIS pathogenesis and summarizes therapeutic strategies that have been used for IRIS.

Clinical manifestations and risk factors for oral immune reconstitution inflammatory syndrome in Mexico

Oral Diseases ◽  
2020 ◽  
Vol 26 (S1) ◽  
pp. 153-157
Author(s):  
Itzel Castillejos‐García ◽  
Velia Ramírez‐Amador ◽  
Eduardo Gómez‐Mejía ◽  
Florentino Badial‐Hernández ◽  
Gabriela Anaya‐Saavedra
Keyword(s):  
Risk Factors ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Clinical Manifestations ◽  
Inflammatory Syndrome

scholarly journals Disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a female patient with HIV infection

2021 ◽  
Vol 14 (5) ◽  
pp. e241037
Author(s):  
Jacqueline Alexandra Bachofner ◽  
Kristian Ikenberg ◽  
Bettina Schulthess ◽  
Johannes Nemeth
Keyword(s):  
Hiv Infection ◽  
Mycobacterium Avium ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Avium Infection ◽  
Inflammatory Syndrome ◽  
Mycobacterium Simiae ◽  
Mycobacterium Avium Infection ◽  
Standard Treatment Regimen

This case study discusses the management of a disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a 52-year-old woman with HIV infection. Disseminated M. avium infections have extensively been described in HIV patients; however, reports of infections with M. simiae are rare. Treatment of M. simiae infections is challenging due to its high rates of natural drug resistances, and thus far, no standard treatment regimen exists.

scholarly journals Progressive multifocal leukoencephalopathy and immune reconstitution inflammatory syndrome in seven patients with sarcoidosis: a critical discussion of treatment and prognosis

2021 ◽  
Vol 14 ◽  
pp. 175628642110355
Author(s):  
Maike F. Dohrn ◽  
Gisa Ellrichmann ◽  
Rastislav Pjontek ◽  
Carsten Lukas ◽  
Jens Panse ◽  
...  
Keyword(s):  
Progressive Multifocal Leukoencephalopathy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Opportunistic Infections ◽  
Jc Virus ◽  
Immunosuppressive Treatment ◽  
Interleukin 2 ◽  
Cerebral Magnetic Resonance Imaging ◽  
Virus Load ◽  
Inflammatory Syndrome

Progressive multifocal leukoencephalopathy (PML) is a subacute brain infection by the opportunistic John Cunningham (JC) virus. Herein, we describe seven patients with PML, lymphopenia, and sarcoidosis, in three of whom PML was the first manifestation of sarcoidosis. At onset, the clinical picture comprised rapidly progressive spastic hemi- or limb pareses as well as disturbances of vision, speech, and orientation. Cerebral magnetic resonance imaging showed T2-hyperintense, confluent, mainly supratentorial lesions. Four patients developed punctate contrast enhancement as a radiological sign of an immune reconstitution inflammatory syndrome (IRIS), three of them having a fatal course. In the cerebrospinal fluid, the initial JC virus load (8–25,787 copies/ml) did not correlate with interindividual severity; however, virus load corresponded to clinical dynamics. Brain biopsies ( n = 2), performed 2 months after symptom onset, showed spotted demyelination and microglial activation. All patients had lymphopenia in the range of 270–1150/µl. To control JC virus, three patients received a combination of mirtazapine and mefloquine, another two patients additionally took cidofovir. One patient was treated with cidofovir only, and one patient had a combined regimen with mirtazapine, mefloquine, cidofovir, intravenous interleukin 2, and JC capsid vaccination. To treat sarcoidosis, the four previously untreated patients received prednisolone. Three patients had taken immunosuppressants prior to PML onset, which were subsequently stopped as a potential accelerator of opportunistic infections. After 6–54 months of follow up, three patients reached an incomplete recovery, one patient progressed, but survived so far, and two patients died. One further patient was additionally diagnosed with lung cancer, which he died from after 24 months. We conclude that the combination of PML and sarcoidosis is a diagnostic and therapeutic challenge. PML can occur as the first sign of sarcoidosis without preceding immunosuppressive treatment. The development of IRIS might be an indicator of poor outcome.

scholarly journals Immune Reconstitution Inflammatory Syndrome with Recurrent Paradoxical Cerebellar HIV-Associated Progressive Multifocal Leukoencephalopathy

Pathogens ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 813
Author(s):  
Paola Frattaroli ◽  
Teresa A. Chueng ◽  
Obinna Abaribe ◽  
Folusakin Ayoade
Keyword(s):  
Progressive Multifocal Leukoencephalopathy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
People Living With Hiv ◽  
Rare Presentation ◽  
Diagnosis And Management ◽  
Art Initiation ◽  
Cerebellar Lesions ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Progressive multifocal leukoencephalopathy (PML), presenting as immune reconstitution inflammatory syndrome (IRIS), is a known complication of antiretroviral therapy (ART) in people living with HIV (PLWH). Typically preceded by ART initiation, IRIS may appear simultaneously/unmasked (PML-s-IRIS) or as a delayed/worsening/paradoxical (PML-d-IRIS) presentation of known PML disease. Primary cerebellar tropism continues to be a rare presentation, and paradoxical cerebellar involvement of PML-IRIS syndrome can be a challenge for both diagnosis and management. Steroids have been suggested as a possible therapy in severe cases but the duration of steroid therapy remain elusive. Our case is that of a 34-year-old man with newly diagnosed HIV simultaneously found to have cerebellar PML. His PML lesions however worsened after initiation of ART (PML-d-IRIS) with evidence of increased intracranial pressure. Despite initial favorable response to a short duration of steroids, he had multiple recurrence of his PML lesions after steroids were discontinued. The presence of predominant cerebellar lesions and the question of how long steroids should be provided to prevent or minimize PML recurrence is the highlight of our case. This report emphasizes the need for more controlled studies to assist clinicians in the optimal diagnosis and management of PML-IRIS in PLWH.

scholarly journals MRI imaging features of HIV-related central nervous system diseases: diagnosis by pattern recognition in daily practice

2021 ◽  
Author(s):  
Mio Sakai ◽  
Masahiro Higashi ◽  
Takuya Fujiwara ◽  
Tomoko Uehira ◽  
Takuma Shirasaka ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Pattern Recognition ◽  
Nervous System ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Opportunistic Infections ◽  
Primary Cns Lymphoma ◽  
Imaging Features ◽  
Cns Diseases ◽  
Inflammatory Syndrome

AbstractWith the advent of antiretroviral therapy (ART), the prognosis of people infected with human immunodeficiency virus (HIV) has improved, and the frequency of HIV-related central nervous system (CNS) diseases has decreased. Nevertheless, mortality from HIV-related CNS diseases, including those associated with ART (e.g., immune reconstitution inflammatory syndrome) remains significant. Magnetic resonance imaging (MRI) can improve the outlook for people with HIV through early diagnosis and prompt treatment. For example, HIV encephalopathy shows a diffuse bilateral pattern, whereas progressive multifocal leukoencephalopathy, HIV-related primary CNS lymphoma, and CNS toxoplasmosis show focal patterns on MRI. Among the other diseases caused by opportunistic infections, CNS cryptococcosis and CNS tuberculosis have extremely poor prognoses unless diagnosed early. Immune reconstitution inflammatory syndrome shows distinct MRI findings from the offending opportunistic infections. Although distinguishing between HIV-related CNS diseases based on imaging alone is difficult, in this review, we discuss how pattern recognition approaches can contribute to their early differentiation.

Immune reconstitution inflammatory syndrome associated with secondary syphilis: dermatologic, neurologic and ophthalmologic compromise in an HIV patient

2019 ◽  
Vol 30 (5) ◽  
pp. 509-511
Author(s):  
Sami Alcedo ◽  
Renee Newby ◽  
Juan José Montenegro ◽  
Paola Rondan ◽  
Jorge Arevalo ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Secondary Syphilis ◽  
Immune Reconstitution Syndrome ◽  
Clinical Expression ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The presentation of syphilis as a manifestation of immune reconstitution inflammatory syndrome in patients with human immunodeficiency virus (HIV) infection is rare and can be associated with the varied clinical expression of unusual syphilitic manifestations. We report a case of immune reconstitution syndrome with dermatologic, ophthalmologic and neurologic compromise of secondary syphilis in a patient with HIV infection.

scholarly journals Immune reconstitution inflammatory syndrome in tuberculous pleurisy and ulcerative colitis: a case report

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Federico Piffer ◽  
Guido Levi ◽  
Giampietro Marchetti ◽  
Chiara Barbieri
Keyword(s):  
Ulcerative Colitis ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Opportunistic Infections ◽  
Central Nervous System Involvement ◽  
Number Of Patients ◽  
Patients At Risk ◽  
Tuberculous Pleurisy ◽  
Few Data ◽  
Inflammatory Syndrome

We present the case of a 46-year-old Caucasian male, affected by ulcerative colitis, who developed tuberculous pleurisy during immunosuppressive therapy; despite proper therapy, worsening of the radiological findings was observed. The case was discussed among an online group of Italian physicians and diagnosis of immune reconstitution inflammatory syndrome (IRIS) tuberculosis was established. Therapy was continued and full recovery was obtained. IRIS is a syndrome initially described during opportunistic infections in HIV infected after being placed in anti-retroviral therapy. It reveals itself through a wide variety of manifestations, including fever, lymphadenopathies, worsening of lung infiltrates, pleural or pericardial effusion, central nervous system involvement. Few data are available regarding the best therapeutic options. IRIS is an insidious and potentially serious complication of opportunistic infections in immunocompromised patients. The always wider diffusion of immunosuppressive therapies increases the number of patients at risk, therefore physicians need to be aware of the issue.

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