Symptomatic Schistosoma mansoni Infection as an Immune Restoration Phenomenon in a Patient Receiving Antiretroviral Therapy

Silva, S. de; Walsh, Julia; Brown, Michael J.

doi:10.1086/499109

Cited by 35 publications

(26 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three case reports have described IRD associated with schistosomiasis; in one, eosinophilia developed shortly after initiation of ART [44] and, in the other studies, patients developed enteritis [45] and colonic inflammatory polyposis [46]. These manifestations are consistent with our understanding of the disorder of Schistosoma mansoni infection, which results from host granulomatous inflammation in response to schistosomal eggs within the colonic mucosa.…”

Section: Parasitic Infections and Immune Reconstitution Diseasesupporting

confidence: 55%

Immune reconstitution disease: recent developments and implications for antiretroviral treatment in resource-limited settings

Lawn

French²

2007

Current Opinion in HIV and AIDS

View full text Add to dashboard Cite

show abstract

Section: Parasitic Infections and Immune Reconstitution Diseasesupporting

confidence: 55%

Immune reconstitution disease: recent developments and implications for antiretroviral treatment in resource-limited settings

Lawn

French²

2007

Current Opinion in HIV and AIDS

View full text Add to dashboard Cite

show abstract

“…The disparity in the current versus previous findings may be partly due to the relative frequency of various IRIS events across the two studies. In the previous studies, IRIS diagnosis was based on consensus expert opinion, and classified by mode of presentation (paradoxical worsening of known opportunistic infection [OI] or unmasking of sub-clinical disease) while in the current study, IRIS was defined as either the re-emergence of symptoms of otherwise successfully treated chronic schistosomiasis on initiation of HAART or the production of schistosome eggs by individuals who were not producing eggs before initiating them on HAART [38]. The symptoms of schistosomiasis-associated IRIS included at least three of the following: hepato-splenomegaly; ultra-sound finding or clinical signs of hypertension; ultra-sound finding or clinical signs of increased granuloma formation/liver fibrosis; haematuria; and egg production in stool (whose presence could not be explained by other possible cause).…”

Section: Discussionmentioning

confidence: 99%

“…Schistosomiasis-associated IRIS was defined as either the re-emergence of symptoms of otherwise successfully treated schistosomiasis on initiation of HAART or the production of schistosome eggs by individuals who were not producing eggs before initiating HAART [38]. The chronic symptoms of schistosomiasis-associated IRIS included at least three of the following: hepato-splenomegaly; ultra-sound finding or clinical signs of hypertension; ultra-sound finding or clinical signs of increased granuloma formation/liver fibrosis; haematuria; and egg production in stool (whose presence could not be explained by other possible cause).…”

Section: Methodsmentioning

confidence: 99%

A non-synonymous polymorphism in IL-23R Gene (rs1884444) is associated with reduced risk to schistosomiasis-associated Immune Reconstitution Inflammatory Syndrome in a Kenyan population

et al. 2014

View full text Add to dashboard Cite

BackgroundHuman Immunodeficiency Virus (HIV) and Schistosomiasis co-infection is common among residents at the shores of Lake Victoria in Kenya. About 36% of this population initiating antiretroviral therapy (ART) experience Immune Reconstitution Inflammatory Syndrome (IRIS) that complicates recovery. Several IL-23R alleles have been associated with susceptibility to both autoimmune and inflammatory diseases through T-helper type 17 (TH17) cells. However, whether or not variants within the IL-23R increase susceptibility to IRIS in western Kenya is unknown. The objective of the current study was to determine the association between IL-23R gene polymorphisms, CD4+ cell counts and HIV RNA levels and IRIS in HIV and Schistosoma mansoni co-infected patients undergoing highly active anti-retroviral therapy (HAART).MethodsA three-month case–control study was conducted on antiretroviral naïve schistosomiasis/HIV co-infected fishermen starting HAART in Uyoma Rarieda, Siaya County, Kenya. Seventy one patients were sampled at baseline and followed up for three months, to establish if they developed Schistosoma-related IRIS. In addition, the CD4+ cell counts and HIV RNA levels were determined in pre- and post-administration of HAART. Variations at five polymorphic sites of IL-23R (rs1884444, rs11465754, rs6682925, rs7530511 and rs7539625) based on >10% minor allele frequency in Yoruban reference population was determined using Allelic Discrimination Assay. The association between the five variants and susceptibility to IRIS was determined using logistic regression while controlling for potential confounders. In addition, the functional differences between the baseline CD4 + Cell counts and viral loads were determined using medians while across IL-23R genotypes were determined using Kruskal-Wallis tests.ResultsOverall, 26 (36.6%) patients developed schistosomiasis-associated IRIS at a median age of 35.5 years. Carriage of the TT genotype at the non-synonymous rs1884444 T > G relative to GG, was associated with a decreased risk of schistosomiasis-associated IRIS (OR, 0.25, 95% CI, 0.07-0.96, P = 0.043) while both baseline CD4+ cell counts and viral loads had no association with IRIS.ConclusionThese findings indicate that the non-synonymous variant rs1884444 T > G of IL-23R is associated with a decreased risk to schistosomiasis-associated IRIS. However, additional studies in a larger cohort and with an all inclusive polymorphic variants in the synonymous and non-synonymous regions need to be evaluated.

show abstract

“…One patient presented with eosinophilia and hepatosplenomegaly [66], the second with vomiting, diarrhoea and abdominal pain [67], and the third with schistosomal colonic polyposis [68]. All three cases were unmasking IRIS cases.…”

Section: Schistosomiasismentioning

confidence: 94%

“…Three cases of Schistosoma mansoni-related IRIS were diagnosed in high-income countries among immigrants from countries where Schistosoma infection is endemic [66][67][68]. One patient presented with eosinophilia and hepatosplenomegaly [66], the second with vomiting, diarrhoea and abdominal pain [67], and the third with schistosomal colonic polyposis [68].…”

Section: Schistosomiasismentioning

confidence: 99%

The immune reconstitution inflammatory syndrome related to HIV co-infections: a review

Veld

Sun

Hung

et al. 2011

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

The immune reconstitution inflammatory syndrome (IRIS) is a consequence of an excessive pathogen-specific immune recovery reaction and occurs in a subset of patients on antiretroviral therapy (ART). Infective forms of IRIS may present either as an 'unmasking' of a previously subclinical infection or the paradoxical clinical deterioration of an infection for which the patient received appropriate antimicrobial therapy. The most important risk factors for IRIS are a low CD4+ T-cell count and a short time between treatment of the infection and the commencement of ART. The general approach to the treatment of IRIS is to continue ART and provide antimicrobial therapy for the provoking infection. The majority of cases are self-limiting; however, mortality and hospitalisation rates are particularly high when tuberculosis- or cryptococcal-IRIS affects the central nervous system (CNS). Corticosteroid therapy should be considered in certain forms of IRIS after the exclusion of other conditions that could explain the inflammatory manifestations in the patients. Given that a low CD4+ T-cell count is a major risk factor for the development of IRIS, commencing ART at a CD4+ T-cell count of >350/μL will prevent most cases.

show abstract

Symptomatic Schistosoma mansoni Infection as an Immune Restoration Phenomenon in a Patient Receiving Antiretroviral Therapy

Cited by 35 publications

References 7 publications

Immune reconstitution disease: recent developments and implications for antiretroviral treatment in resource-limited settings

Immune reconstitution disease: recent developments and implications for antiretroviral treatment in resource-limited settings

A non-synonymous polymorphism in IL-23R Gene (rs1884444) is associated with reduced risk to schistosomiasis-associated Immune Reconstitution Inflammatory Syndrome in a Kenyan population

The immune reconstitution inflammatory syndrome related to HIV co-infections: a review

Contact Info

Product

Resources

About