Tumor necrosis factor-alpha inhibitors for extended or severe neurological immune reconstitution inflammatory syndrome in HIV-infected patients

Abstract

Tumor necrosis factor-alpha inhibitors for extended or severe neurological immune reconstitution inflammatory syndrome in HIV-infected patientsThe management of moderate-to-severe immune reconstitution inflammatory syndrome (IRIS) requires corticosteroid use in most symptomatic patients [1][2][3][4]. However, this treatment appears to be insufficient on its own in neurological IRIS, which is associated with a high mortality rate [2,5], and in persistent IRIS, exposing patients to a risk of long-term complications of corticosteroid use [6].Tumor necrosis factor-alpha inhibitors (TNF-I) are considered a useful option in cases of relapse or nonresponse to corticosteroids [7]. TNF-alpha plays a specific role in controlling mycobacterial infection and granuloma formation, but, at high levels, it may cause detrimental inflammation and increase the incidence of IRIS [8].We retrospectively collected data from six French HIV-1infected patients (Table 1) between March 2016 and August 2017. The median age of the patients was 38 years , and three of the patients were women. Five patients had bacteriological proven tuberculosis (TB), including two cases of neurological TB [e.g. TB with central nervous system (CNS) involvement]. One patient (number 6) had bacteriological proven cryptococcal meningitis.