Central Nervous System Immune Reconstitution Inflammatory Syndrome

Abstract

Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS) develops in 9 %–47 % of persons with HIV infection and a CNS opportunistic infection who start antiretroviral therapy and is associated with a mortality rate of 13 %–75 %. These rates vary according to the causative pathogen. Common CNS-IRIS events occur in relation to Cryptococcus, tuberculosis (TB), and JC virus, but several other mycobacteria, fungi, and viruses have been associated with IRIS. IRIS symptoms often mimic the original infection, and diagnosis necessitates consideration of treatment failure, microbial resistance, and an additional neurological infection. These diagnostic challenges often delay IRIS diagnosis and treatment. Corticosteroids have been used to treat CNS-IRIS, with variable responses; the best supportive evidence exists for the treatment of TB-IRIS. Pathogenic mechanisms vary: Cryptococcal IRIS is characterized by a paucity of cerebrospinal inflammation prior to antiretroviral therapy, whereas higher levels of inflammatory markers at baseline predispose to TB meningitis IRIS. This review focuses on advances in the understanding of CNS-IRIS over the past 2 years.

Epidemiology of Meningitis in an HIV-Infected Ugandan Cohort

“…Persons known to be receiving ART were excluded as immune reconstitution inflammatory syndrome (IRIS) creates different diagnostic considerations beyond the scope of our aims. 26 Clinical suspicion for meningitis was based on one or more symptoms of headache, fever, neck stiffness, or altered mental status. The CSF was obtained for routine examination and microbiological testing, as described below.…”

Manifestaciones Neurológicas en Pacientes Ambulatorios con Diagnóstico de VIH Atendidos en el Hospital Carlos Andrade Marín.

“…La aparición de signos neurológicos o deterioro de los déficits previos son la forma de presentación más común del síndrome e reconstitución inmune y la mayoría de los casos de asocian a neuroinfecciones [39,40]. La distribución en el presente estudio fue similar al reporte de McCombe y colaboradores en Canadá, no existieron casos ambulatorios de síndrome de Guillain Barré ni de esclerosis lateral amiotrófica [41].…”

Management of HIV-associated cryptococcal disease in South Africa

“…Paradoxical IRIS is defined as the recurrence of symptoms/signs of a previously treated opportunistic infection (OI). [28,32] Paradoxical IRIS occurs in 6 -45% of patients with prior CM. [28] After ART initiation, paradoxical IRIS may occur at a median of 1 -2 months or, in some instances, 8 -9 months later.…”