High Incidence of Herpes Zoster in Patients with AIDS Soon After Therapy with Protease Inhibitors

Martínez, Estebán; Gatell, José M.; Morán, Yolanda; Aznar, E. Ubiña; Buira, Elisabet; Guelar, Ana; Mallolas, J; Soriano, E

doi:10.1086/515019

Cited by 130 publications

(94 citation statements)

References 12 publications

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“…Cohort studies of adults and children indicated that the incidence of VZV disease ranged from 5 to 12%, with most cases occurring in the first 16 weeks of therapy (Table 2). A low CD4 T-cell count was a risk factor in children (140) but not in adults (40,42,90). VZV disease after commencement of ART usually presents as shingles affecting a single dermatome but may present as multidermatomal shingles, Ramsay-Hunt syndrome (M. A. French, personal observations), or myelitis (20,29).…”

Section: Ird Associated With Hsv or Vzv Infection May Be Mediated By mentioning

confidence: 99%

“…Following the introduction of ART in the mid-1990s, cases of dermatomal herpes zoster were up to five times more common in patients who had recently commenced ART (1,90). Cohort studies of adults and children indicated that the incidence of VZV disease ranged from 5 to 12%, with most cases occurring in the first 16 weeks of therapy (Table 2).…”

Section: Ird Associated With Hsv or Vzv Infection May Be Mediated By mentioning

confidence: 99%

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Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

et al. 2009

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SUMMARY Up to one in four patients infected with human immunodeficiency virus type 1 and given antiretroviral therapy (ART) experiences inflammatory or cellular proliferative disease associated with a preexisting opportunistic infection, which may be subclinical. These immune restoration diseases (IRD) appear to result from the restoration of immunocompetence. IRD associated with intracellular pathogens are characterized by cellular immune responses and/or granulomatous inflammation. Mycobacterial and cryptococcal IRD are attributed to a pathological overproduction of Th1 cytokines. Clinicopathological characteristics of IRD associated with viral infections suggest different pathogenic mechanisms. For example, IRD associated with varicella-zoster virus or JC polyomavirus infection correlate with a CD8 T-cell response in the central nervous system. Exacerbations or de novo presentations of hepatitis associated with hepatitis C virus (HCV) infection following ART may also reflect restoration of pathogen-specific immune responses as titers of HCV-reactive antibodies rise in parallel with liver enzymes and plasma markers of T-cell activation. Correlations between immunological parameters assessed in longitudinal sample sets and clinical presentations are required to illuminate the diverse immunological scenarios described collectively as IRD. Here we present salient clinical features and review progress toward understanding their pathogeneses.

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Section: Ird Associated With Hsv or Vzv Infection May Be Mediated By mentioning

confidence: 99%

Section: Ird Associated With Hsv or Vzv Infection May Be Mediated By mentioning

confidence: 99%

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

et al. 2009

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“…Also, HIV-infected patients initiating both therapies are more prone to develop transient chest radiographic worsening than HIV-uninfected and HIV-infected patients not on AR therapy 4 . Enhancing host immunity following initiation of AR therapy or its intensification with a protease inhibitor has also been implicated in the emergence of cytomegalovirus retinitis 6 , Mycobacterium avium complex lymphadenitis 14 , development of zoster rash 9 , rapid worsening of Kaposi's sarcoma lesions 7 and development of multiple cerebral lesions compatible with progressive multifocal leukoencephalopathy in AIDS patients 7 .…”

Section: Discussionmentioning

confidence: 99%

Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease

Eyer-Silva

Pinto

Arabe

et al. 2002

Rev. Soc. Bras. Med. Trop.

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The development of paradoxical clinical worsening following initiation of tuberculosis treatment may complicate the clinical course of both HIV-infected and uninfected patients. We report a severe manifestation of the so called paradoxical reaction to the treatment of tuberculosis that unmasked previously silent meningeal disease in a 34-year-old HIV-infected male patient. Key-words: AIDS. Antiretroviral therapy. Paradoxical reaction. Tuberculosis. Tuberculous meningitis.Resumo O desenvolvimento de piora clínica paradoxal como resposta ao início do tratamento da tuberculose pode complicar a evolução de pacientes com e sem infecção pelo HIV. Apresentamos uma grave manifestação da chamada reação paradoxal ao tratamento da tuberculose, que revelou doença meníngea previamente silenciosa em um paciente HIV-positivo de 34 anos. Palavras-chaves: AIDS. Meningite tuberculosa. Reação paradoxal. Terapia anti-retroviral. Tuberculose. Concomitantly treating active tuberculosis (TB) and HIV infection is a challenging task. There is a great potential for adverse effects and clinically significant pharmacological interactions. The development of paradoxical clinical worsening on TB treatment may further complicate patient management. We report a life-threatening manifestation of paradoxical worsening following TB treatment initiation in an antiretroviral (AR)-experienced patient. CASE REPORTA 34-year-old HIV-infected male patient with previous experience to the HIV reverse transcriptase inhibitors zidovudine and didanosine, to the HIV protease inhibitor saquinavir and on Pneumocystis carinii prophylaxis developed an enlarging cervical mass associated with a 2-month history of fever, weigh loss and malaise. At that point laboratory evaluation showed mild anemia (hemoglobin 11,3mg/dL), 60 CD4 cells/mm 3 and a plasma HIV viral load of 25,000 copies/mL (all viral load measurements were performed using the nucleic acid sequence-based amplification assay). Chest X-ray was normal. He had never had an opportunistic disorder but was treated for pleural TB during early adulthood. Histopathology disclosed TB lymphadenitis and Mycobacterium tuberculosis grew from the node aspirate. Rifabutin (as an alternative rifamycin to be combined with a protease inhibitor) at a dose of 150mg/day, isoniazid, pyridoxine and pyrazinamide were started and the AR regimen was changed to stavudine, lamivudine and indinavir. He significantly improved and remained well until ten weeks later when recrudescence of fever and severe headache developed. Signs of meningeal irritation were absent, as were cognitive, behavioral or focal neurologic abnormalities. Computed tomography of the brain was normal. Cerebrospinal fluid (CSF) studies revealed marked pleocytosis (220 cells/mm 3 , 71% polymorphonuclear, 29% mononuclear cells), glucose 52mg/dL and elevated protein (156mg/dL) and were negative for acid-fast bacilli, mycobacterial cultures, other infectious agents and neoplastic cells. Ophthalmologic examination disclosed TB choroidal nodules (previous evalu...

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“…This same phenomenon, including treatment-induced appearance of shingles, has also been reported in IRIS. 92 …”

Section: Subclinical Infectionmentioning

confidence: 99%

Immunostimulation in the era of the metagenome

Proal

Albert

Blaney³

et al. 2011

Cell Mol Immunol

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Microbes are increasingly being implicated in autoimmune disease. This calls for a re-evaluation of how these chronic inflammatory illnesses are routinely treated. The standard of care for autoimmune disease remains the use of medications that slow the immune response, while treatments aimed at eradicating microbes seek the exact opposite-stimulation of the innate immune response. Immunostimulation is complicated by a cascade of sequelae, including exacerbated inflammation, which occurs in response to microbial death. Over the past 8 years, we have collaborated with American and international clinical professionals to research a model-based treatment for inflammatory disease. This intervention, designed to stimulate the innate immune response, has required a reevaluation of disease progression and amelioration. Paramount is the inherent conflict between palliation and microbicidal efficacy. Increased microbicidal activity was experienced as immunopathology-a temporary worsening of symptoms. Further studies are needed, but they will require careful planning to manage this immunopathology.

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High Incidence of Herpes Zoster in Patients with AIDS Soon After Therapy with Protease Inhibitors

Cited by 130 publications

References 12 publications

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease

Immunostimulation in the era of the metagenome

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