Immune Reconstitution Inflammatory Syndrome

Manabe, Yukari C.; Campbell, James D.; Sydnor, Emily; Moore, Richard D.

doi:10.1097/qai.0b013e3181594c8c

Cited by 168 publications

(56 citation statements)

References 36 publications

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“…The increased odds of developing IRIS in individuals with HIV infection and CD4 cell counts of <50 cells/mm 3 prior to initiating cART is consistent with prior studies (Manabe et al, 2007; Falco et al, 2008). This could be due to the rapidity of immune reconstitution in those who are more severely immunosuppressed compared to those who are not; or perhaps due to more extensive opportunistic infection in these individuals.…”

Section: Discussionsupporting

confidence: 88%

“…Associated risk factors are HIV-infection, preexisting opportunistic infection, being cART naïve, having a low nadir CD4 count prior to cART, and achieving a substantial decline in HIV viral load after instituting cART (Shelburne et al, 2005; Manabe et al, 2007; Dhasmana et al, 2008). As much as 23% of HIV-infected patients with PML who recently started cART will develop PML-IRIS (Cinque et al, 2001; Falco et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Immune reconstitution is not a prognostic factor in progressive multifocal leukoencephalopathy

Harrison

Newsome

Skolasky

et al. 2011

Journal of Neuroimmunology

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Progressive multifocal leukoencephalopathy (PML) is typically associated with minimal inflammation; however, patients may develop an inflammatory response due to immune reconstitution (IRIS). The authors aimed to determine if characteristics and outcomes of PML are altered in those with IRIS. A retrospective records review was performed on 87 patients diagnosed with PML at Johns Hopkins, 27 of which had a syndrome consistent with IRIS. Gadolinium enhancement on MRI occurred in 44.4% of cases of PML-IRIS versus 5.1% in PML (p<0.05), and thus had low diagnostic sensitivity and specificity. In HIV+ cases, CD4 counts were lower in those who later developed IRIS (mean 34.8 vs. 71.7, p<0.05) and was predictive of the development of IRIS (p<0.05). Improved prognosis was seen with higher cerebrospinal fluid (CSF) white blood cell counts and protein levels, but not for gadolinium enhancement and there were no differences in survival for PML versus PML-IRIS.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Immune reconstitution is not a prognostic factor in progressive multifocal leukoencephalopathy

Harrison

Newsome

Skolasky

et al. 2011

Journal of Neuroimmunology

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“…Extensive evaluation of our patient was negative for common causes of hypercalcemia. In patients with HIV, granulomatous opportunistic infections are of concern since granulomatous reactivation can be associated with initiation of ART in patients with CD4 + T-cell counts < 100 cells/ml [5]. However, this was not compatible with our patient, as he maintained stable CD4 + T-cell counts (> 300 cells/ml) and had no history of opportunistic infections.…”

Section: Discussionmentioning

confidence: 70%

A Case of Hypercalcemia and Overexpression of CYP27B1 in Skeletal Muscle Lesions in a Patient with HIV Infection After Cosmetic Injections with Polymethylmethacrylate (PMMA) for Wasting

et al. 2015

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Foreign body-induced granuloma is an uncommon yet clinically significant cause of hypercalcemia. The molecular mechanisms are uncertain, although extrarenal calcitriol production has been proposed. We describe severe hypercalcemia associated with increased levels of plasma calcitriol in a patient with HIV and local granulomatous reaction five years after injection of polymethylmethacrylate (PMMA) as dermal filler for cosmetic body sculpting. Extensive evaluation revealed no identifiable cause of increased calcitriol levels. Nuclear imaging was remarkable for diffuse uptake in the subcutaneous tissues of the buttocks. Subsequent muscle biopsy and immunohistochemical staining showed strong local expression of CYP27B1 within histiocytes surrounding globules of PMMA. This case highlights an unfortunate complication of dermal fillers and shows that inflammatory cells can express high levels of CYP27B1 even without frank granulomas. The growing trend of body contour enhancement using injectable fillers should raise suspicion for this cause of hypercalcemia in clinical practice. Patients with HIV who receive this treatment for lipodystrophy or other cosmetic purposes may have increased susceptibility to hypercalcemia in the setting of underlying chronic inflammation. This may be a concern when changing anti-retroviral therapy, since alterations in levels of HIV viremia may initiate or contribute to worsening hypercalcemia.

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“…The most immunosuppressed patients with a CD4 T cell count < 100 cells/ml treated with the most potent regimens, particularly PIs, resulting in significant HIV viral load declines are at greatest risk for the development of IRS after HAART initiation [8]. Even though it is an uncommon manifestation of IRS, we think that Clinicians will have to consider the importance of the early diagnosis to bring an adequate treatment and to decrease the associated morbidity of Graves' disease.…”

Section: Resultsmentioning

confidence: 99%

“…The most immunosuppressed patients with a CD4 T cell count less than 100 cells/ml treated with the most potent regimens, particularly PIs, resulting in significant HIV viral load declines, are at greatest risk for the development of IRS after HAART initiation [8].…”

Section: Discussionmentioning

confidence: 99%

Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient

Mingote¹,

Urrutia²,

Viteri³

et al. 2013

WJA

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Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves' disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves' disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/µL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/µL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves' disease, which was diagnosed when CD4 T-cells increased up to 343 cell/µL. Our patient developed Graves' disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/µL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.

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Immune Reconstitution Inflammatory Syndrome

Abstract: The most immunosuppressed patients treated with the most potent regimens, particularly BPI-based regimens, resulting in significant HIV viral load declines are at greatest risk for the development of IRIS after HAART initiation.

Cited by 168 publications

References 36 publications

Immune reconstitution is not a prognostic factor in progressive multifocal leukoencephalopathy

Immune reconstitution is not a prognostic factor in progressive multifocal leukoencephalopathy

A Case of Hypercalcemia and Overexpression of CYP27B1 in Skeletal Muscle Lesions in a Patient with HIV Infection After Cosmetic Injections with Polymethylmethacrylate (PMMA) for Wasting

Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient

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