Document Detail


Immune reconstitution inflammatory syndrome in the CNS of HIV-infected patients.
MedLine Citation:
PMID:  16894096     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe challenges in diagnosis and management of patients with clinical syndromes of immune reconstitution inflammatory syndrome (IRIS) involving the CNS.
METHODS: The authors describe three patients with clinically distinct neurologic manifestations of IRIS with HIV infection who presented as diagnostic and therapeutic challenges.
RESULTS: One patient with cryptococcal meningitis developed acute cerebellitis with mass effect and brainstem compression. Corticosteroid therapy was associated with complete resolution of the cerebellar lesion but the patient developed VZV encephalitis. Another patient with progressive multifocal leukoencephalopathy developed subacute progression of focal neurologic deficits associated with contrast enhancing lesions on brain MRI. This patient had spontaneous resolution of the lesion but was left with residual deficits. One patient developed a progressive dementing syndrome and deterioration over several months resulting in coma during combination antiretroviral therapy. A brain biopsy in this latter patient showed massive infiltration of T lymphocytes predominantly of the CD8 subtype. This patient had a significant improvement with corticosteroids and change in antiretroviral regimen although she was left with residual cognitive impairment.
CONCLUSIONS: Immune reconstitution inflammatory syndrome should be suspected in patients who show clinical or radiologic deterioration following initiation of antiretroviral therapy accompanied with improvement in CD4 cell count and viral load. Some patients may respond to a brief course of treatment with corticosteroids.
Authors:
A Venkataramana; C A Pardo; J C McArthur; D A Kerr; D N Irani; J W Griffin; P Burger; D S Reich; P A Calabresi; A Nath
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurology     Volume:  67     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-08     Completed Date:  2006-09-06     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  383-8     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections
Adrenal Cortex Hormones / therapeutic use*
Antiretroviral Therapy, Highly Active
Autoimmune Diseases of the Nervous System / drug therapy*,  etiology*,  virology
CD4 Lymphocyte Count
Central Nervous System Diseases / etiology,  virology
HIV Infections / complications*,  drug therapy
Humans
Viral Load
Grant Support
ID/Acronym/Agency:
K08 DA016160/DA/NIDA NIH HHS; K08 DA016160-04/DA/NIDA NIH HHS
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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