Immune reconstitution inflammatory syndrome associated with Mycobacterium tuberculosis infection: a systematic review

Leone, Sebastiano; Nicastri, Emanuele; Giglio, Sergio; Narciso, Pasquale; Ippolito, Giuseppe; Acone, Nicola

doi:10.1016/j.ijid.2009.05.016

Cited by 43 publications

(31 citation statements)

References 66 publications

(65 reference statements)

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“…HAART decreased the incidence of MTB infections and death among patients with AIDS, although some patients experienced temporary worsening of TB (Leone et al, 2010). This phenomenon termed Immune Reconstitution Inflammatory Syndrome (IRIS) is caused by the introduction of HAART, where immune recovery may result in immunological reactions and clinical dete-rioration in patients with TB (Lawn, Bekler, Meller, 2000).…”

Section: Antiretroviral Drugs and Bacterial Agentsmentioning

confidence: 99%

Activity of antiretroviral drugs in human infections by opportunistic agents

Demarchi

Cardozo

Aristides

et al. 2012

Braz. J. Pharm. Sci.

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Highly active antiretroviral therapy (HAART) is used in patients infected with HIV. This treatment has been shown to significantly decrease opportunist infections such as those caused by viruses, fungi and particularly, protozoa. The use of HAART in HIV-positive persons is associated with immune reconstitution as well as decreased prevalence of oral candidiasis and candidal carriage. Antiretroviral therapy benefits patients who are co-infected by the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), Epstein-Barr virus, hepatitis B virus (HBV), parvovirus B19 and cytomegalovirus (CMV). HAART has also led to a significant reduction in the incidence, and the modification of characteristics, of bacteremia by etiological agents such as Staphylococcus aureus, coagulase negative staphylococcus, non-typhoid species of Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. HAART can modify the natural history of cryptosporidiosis and microsporidiosis, and restore mucosal immunity, leading to the eradication of Cryptosporidium parvum. A similar restoration of immune response occurs in infections by Toxoplasma gondii. The decline in the incidence of visceral leishmaniasis/HIV co-infection can be observed after the introduction of protease inhibitor therapy. Current findings are highly relevant for clinical medicine and may serve to reduce the number of prescribed drugs thereby improving the quality of life of patients with opportunistic diseases.
A terapia HAART (terapia antirretroviral altamente ativa) é usada em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e demonstrou diminuição significativa de infecções oportunistas, tais como as causadas por vírus, fungos, protozoários e bactérias. O uso da HAART está associado com a reconstituição imunológica e diminuição na prevalência de candidíase oral. A terapia antirretroviral beneficia pacientes co-infectados pelo HIV, vírus herpes humano 8 (HHV-8), vírus Epstein-Barr (EBV), vírus da hepatite B (HBV), parvovírus B19 e citomegalovírus (CMV). A HAART também apresentou redução significativa da incidência e modificou as características da bacteremia por agentes etiológicos, tais como Staphylococcus aureus, espécies não-tifóides de Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, Mycobacterium tuberculosis. A HAART é capaz de modificar significativamente a história natural da criptosporidiose e microsporidiose. HAART pode efetivamente restaurar a imunidade da mucosa, levando à erradicação de Cryptosporidium parvum. Semelhante restauração da resposta imune ocorre em infecções por Toxoplasma gondii. O declínio na incidência de co-infecção leishmaniose visceral/HIV pode ser observada após a introdução da terapia com inibidores da protease. Os resultados atuais são altamente relevantes para a medicina clínica e podem proporcionar diminuição no número de prescrições medicamentosas e, consequentemente, melhor qualidade de vida para pacientes com doenças oportunistas

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Section: Antiretroviral Drugs and Bacterial Agentsmentioning

confidence: 99%

Activity of antiretroviral drugs in human infections by opportunistic agents

Demarchi

Cardozo

Aristides

et al. 2012

Braz. J. Pharm. Sci.

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“…Because immune reconstitution after cART is the proximate cause of IRIS associated with HIV-1 infection, there is a rationale for delaying or discontinuing cART when symptoms of IRIS emerge, particularly when it occurs in the context of an OI for which effective antimicrobial therapy is available [40]. However, some patients may manifest OI on initiation of cART (simultaneous IRIS), so delaying cART might not prevent the development of OI-associated IRIS.…”

Section: Management Of Cns-iris Associated With Hiv-1 Infectionmentioning

confidence: 99%

Neurologic Consequences of the Immune Reconstitution Inflammatory Syndrome (IRIS)

McCarthy

Nath²

2010

Curr Neurol Neurosci Rep

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Although major advancements have been made in the treatment of HIV infection, graft-versus-host reactions, and autoimmune diseases, an unexpected consequence of treatment has been the emergence of a devastating inflammatory syndrome, termed the immune reconstitution inflammatory syndrome (IRIS). The pathophysiology of the syndrome is poorly understood, and the syndrome poses unique challenges for diagnosis and treatment. We have reviewed the neurologic manifestations of IRIS in the context of HIV infection as well as in the setting of treatment of autoimmune diseases such as multiple sclerosis, in which compartmental immune suppression may occur without an obvious underlying immune suppression. The purpose of this review is to identify common themes that may assist in the diagnosis and management of these IRIS syndromes.

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“…These include his diffuse burden of opportunistic infection at time of diagnosis and ART initiation, relatively low baseline CD4+ T lymphocyte count, initiation of ART shortly after initiation of TB therapy, rapid HIV viral suppression and robust immunologic recovery with ART and high levels of systemic inflammation before starting ART (erythrocyte sedimentation rate of 150 mm/hr and C-reactive protein of 5.5 mg/dL). 2, 3 Although IRIS is the most likely cause of AKI in our patient, tenofovirinduced nephrotoxicity was also considered. Tenofovir therapy, which our patient had started 10 days before his AKI, has been associated with a wide array of renal abnormalities, including ATN, Fanconi syndrome and nephrogenic diabetes insipidus, but nephrotoxicity usually occurs after e382 | www.pidj.com © 2013 Lippincott Williams & Wilkins many months of therapy.…”

mentioning

confidence: 96%

“…2 TB IRIS occurs in between 11% and 45% of adults and up to 20% of children with TB/HIV coinfection who initiate ART, although the incidence in pediatric patients has not been as well characterized. 3,4 Although the immune destruction from TB IRIS often occurs at the primary site of opportunistic infection, it may also occur in organs not previously known to be affected. Kidney involvement is rare but has been reported in several adult patients, typically manifesting as interstitial nephritis with or without granuloma formation.…”

mentioning

confidence: 99%

Denouement

2013

Pediatric Infectious Disease Journal

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Immune reconstitution inflammatory syndrome associated with Mycobacterium tuberculosis infection: a systematic review

Cited by 43 publications

References 66 publications

Activity of antiretroviral drugs in human infections by opportunistic agents

Activity of antiretroviral drugs in human infections by opportunistic agents

Neurologic Consequences of the Immune Reconstitution Inflammatory Syndrome (IRIS)

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