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Immune reconstitution syndrome

Brinda Emu, Jeffrey Fessel, Shannon Schrader, Princy Kumar, Gary Richmond, Sandra Win, Steven Weinheimer, Christian Marsolais, Stanley Lewis
BACKGROUND: Ibalizumab, a humanized IgG4 monoclonal antibody, blocks the entry of human immunodeficiency virus type 1 (HIV-1) by noncompetitive binding to CD4. METHODS: In this single-group, open-label, phase 3 study, we enrolled 40 adults with multidrug-resistant (MDR) HIV-1 infection in whom multiple antiretroviral therapies had failed. All the patients had a viral load of more than 1000 copies of HIV-1 RNA per milliliter. After a 7-day control period in which patients continued to receive their current therapy, a loading dose of 2000 mg of ibalizumab was infused; the viral load was quantified 7 days later...
August 16, 2018: New England Journal of Medicine
Martijn T Wijburg, Clemens Warnke, Frederik Barkhof, Bernard M J Uitdehaag, Joep Killestein, Mike P Wattjes
OBJECTIVE: To test the current progressive multifocal leukoencephalopathy (PML) diagnostic criteria by applying them to patients previously diagnosed with natalizumab (NTZ)-associated PML in a real-world clinical setting. METHODS: Patients from the Dutch-Belgian NTZ-PML cohort (n=28) were reviewed at the time of first diagnostic work-up and during follow-up, using the PML diagnostic criteria as proposed in a consensus statement from the American Academy of Neurology...
August 12, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Odin Goovaerts, Pauline N M Mwinzi, Erick M O Muok, Ann Ceulemans, Robert Colebunders, Luc Kestens
BACKGROUND: Among the different faces of immune reconstitution inflammatory syndrome (IRIS) developing in HIV-patients, no clinical definition has been reported for Schistosomiasis-IRIS (Schisto-IRIS). Although Schisto-IRIS remains largely uninvestigated, matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP) have previously been associated with S. mansoni infection and tuberculosis-IRIS. Here, we aimed to investigate the relevance of these markers in Schisto-IRIS...
August 8, 2018: PLoS Neglected Tropical Diseases
Danielle Mann, Flávia Marinho Sant'Anna, Carolina Arana Stanis Schmaltz, Dayvison Francis Saraiva Freitas, Valeria Cavalcanti Rolla, Solange Cesar Cavalcante, Maria Clara Gutierrez-Galhardo
BACKGROUND: Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE: To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS: We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node...
July 26, 2018: Memórias do Instituto Oswaldo Cruz
Jose Armando Gonzales Zamora, Yogeeta Varadarajalu
Cryptococcosis is a fungal infection that is typically associated with acquired immunodeficiency syndrome (AIDS). The advent of highly active antiretroviral therapy has decreased the frequency of this infection, but has led to the emergence of atypical cases of immune reconstitution inflammatory syndrome (IRIS). Here, we describe the case of a 40-year-old man who was diagnosed with HIV infection and cryptococcal meningitis. He was successfully treated with antifungals and then started antiretroviral therapy...
July 28, 2018: Diseases (Basel)
Rafat Ghabrial, Arjun Ananda, Sebastiaan J van Hal, Elizabeth O Thompson, Stephen R Larsen, Peter Heydon, Ruta Gupta, Svetlana Cherepanoff, Michael Rodriguez, Gabor Michael Halmagyi
Invasive fungal sinusitis causes painful orbital apex syndrome with ophthalmoplegia and visual loss; the mechanism is unclear. We report an immunocompromised patient with invasive fungal sinusitis in whom the visual loss was due to posterior ischaemic optic neuropathy, shown on diffusion-weighted MRI, presumably from fungal invasion of small meningeal-based arteries at the orbital apex. After intensive antifungal drugs, orbital exenteration and immune reconstitution, the patient survived, but we were uncertain if the exenteration helped...
August 2018: Neuro-ophthalmology
Ingrid Eshun-Wilson, Mbah P Okwen, Marty Richardson, Tihana Bicanic
BACKGROUND: There remains uncertainty about the optimum timing of antiretroviral therapy (ART) initiation in HIV-positive people with cryptococcal meningitis. This uncertainty is the result of conflicting data on the mortality risk and occurrence of immune reconstitution inflammatory syndrome (IRIS) when ART is initiated less than four weeks after cryptococcal meningitis treatment is commenced. OBJECTIVES: To compare the outcomes of early initiation of ART (less than four weeks after starting antifungal treatment) versus delayed initiation of ART (four weeks or more after starting antifungal treatment) in HIV-positive people with concurrent cryptococcal meningitis...
July 24, 2018: Cochrane Database of Systematic Reviews
Irina Vlasova-St Louis, Christina C Chang, Samar Shahid, Martyn A French, Paul R Bohjanen
Background: Paradoxical cryptococcosis-associated immune reconstitution inflammatory syndrome (C-IRIS) affects ~25% of human immunodeficiency virus (HIV)-infected patients with cryptococcal meningitis (CM) after they commence antiretroviral therapy (ART) resulting in significant morbidity and mortality. Genomic studies in cryptococcal meningitis and C-IRIS are rarely performed. Methods: We assessed whole blood transcriptomic profiles in 54 HIV-infected subjects with CM who developed C-IRIS (27) and compared the results with control subjects (27) who did not experience neurological deterioration over 24 weeks after ART initiation...
July 2018: Open Forum Infectious Diseases
K Guggenberger, H Urbach
In this review article, typical imaging findings of diseases elicited by immunomodulatory drugs are presented. Progressive multifocal leucoencephalopathy (PML), a subacute infection due to reactivation of the JC virus, has a typical magnetic resonance imaging (MRI) pattern, which must be considered in the framework of immunomodulatory multiple sclerosis (MS) treatment with natalizumab, fingolimod, rituximab and fumarate and also in lymphoproliferative diseases or other forms of immunosuppression. Restoration of the immune system may result in an overlapping and overwhelming immune response in terms of an immune reconstitution inflammatory syndrome (IRIS)...
July 20, 2018: Der Nervenarzt
Alexis Guenette, Shahid Husain, Ana Konvalinka, William Geddie, Coleman Rotstein
There are limited data on blastomycosis in solid organ transplant recipients with the subsequent development of the immune reconstitution inflammatory syndrome (IRIS). Herein we describe a case of pulmonary blastomycosis in a renal transplant recipient with the development of concomitant IRIS.
September 2018: Medical Mycology Case Reports
Hyun Ah Yoon, Antonio Nakouzi, Christina C Chang, Mark H Kuniholm, Leandro J Carreño, Tao Wang, Thumbi Ndung'u, Sharon R Lewin, Martyn A French, Liise-Anne Pirofski
Background: Initiation of antiretroviral therapy (ART) in HIV-infected individuals with cryptococcal meningitis places them at risk for Cryptococcus-associated immune reconstitution inflammatory syndrome (C-IRIS). The relationship between antibody immunity and C-IRIS risk has not been investigated. Methods: We compared plasma levels of immunoglobulins, Cryptococcus neoformans (CN) glucuronoxylomannan (GXM) capsule-specific and (Lam)inarin-binding IgM and IgG, and percentages of peripheral blood total and memory B cells between 27 HIV-infected patients with CM who developed C-IRIS and 63 who did not and evaluated associations of these parameters with risk of C-IRIS...
July 16, 2018: Journal of Infectious Diseases
Joseph N Jarvis, Thomas S Harrison
No abstract text is available yet for this article.
July 16, 2018: Journal of Infectious Diseases
Jinmin Ma, Fang Zhao, Wei Su, Qiongfang Li, Jiandong Li, Jingkai Ji, Yong Deng, Yang Zhou, Xinfa Wang, Huanming Yang, Nitin K Saksena, Karsten Kristiansen, Hui Wang, Yingxia Liu
AIM: Co-infection in HIV-1 patients with Mycobacterium tuberculosis poses considerable risk of developing the immune reconstitution inflammatory syndrome (IRIS), especially upon the initiation of antiretroviral therapy (ART). Methodology & results: For transcriptomic analysis, peripheral blood mononuclear cells' whole gene expression was used from three patient groups: HIV+ (H), HIV-TB+ (HT), HIV-TB+ with IRIS (HTI). Pathway enrichment and functional analysis was performed before and after highly active ART...
July 1, 2018: Personalized Medicine
Yinan Zhang, Crystal Wright, Angela Flores
BACKGROUND: We report the development of asymptomatic progressive multifocal leukoencephalopathy in a patient with multiple sclerosis on natalizumab therapy. Progressive multifocal leukoencephalopathy often presents with debilitating neurologic symptoms. Very few cases have documented a completely asymptomatic course of the disease. CASE PRESENTATION: A 26-year-old white woman with multiple sclerosis was treated with natalizumab. She was diagnosed as having progressive multifocal leukoencephalopathy based on characteristic magnetic resonance imaging lesions after 27 infusions of natalizumab...
July 1, 2018: Journal of Medical Case Reports
Alexander Simonis, Michaela Fux, Gayathri Nair, Nicolas J Mueller, Eugenia Haralambieva, Thomas Pabst, Jana Pachlopnik Schmid, Adrian Schmidt, Urs Schanz, Markus G Manz, Antonia M S Müller
Recently, an immunodeficiency syndrome caused by guanine-adenine-thymine-adenine 2 (GATA2) deficiency has been described. The syndrome is characterized by (i) typical onset in early adulthood, (ii) profound peripheral blood cytopenias of monocytes, B lymphocytes, and NK cells, (iii) distinct susceptibility to disseminated non-tuberculous mycobacterial (NTM) and other opportunistic infections (particularly human papillomavirus), and (iv) a high risk of developing hematologic malignancies (myelodysplastic syndromes (MDS); acute myeloid leukemias (AML))...
June 13, 2018: Annals of Hematology
Ryan K Dean, Rogin Subedi, Ashraya Karkee
Chylous ascites is an uncommon finding of triglyceride-rich lymph in the peritoneal cavity. There are a variety of reported etiologies for chylous ascites; however, the reporting of chylous ascites among AIDS/HIV-positive patients is quite uncommon. This finding as a complication of immune reconstitution inflammatory syndrome is even more unusual. Here we report a case of an HIV-positive man with a history of colonic Mycobacterium avium complex who developed chylous ascites in the setting of increasing CD4 counts and decreasing viral load, suggestive of immune reconstitution inflammatory syndrome...
July 2018: Proceedings of the Baylor University Medical Center
Neera Sharma, Lokesh Kumar Sharma, Atul Anand, Adesh Kisanji Gadpayle, Kumar Gaurav, Sabyasachi Mukherjee, Bindu Kulshreshtha, Deep Dutta
Background & objectives: : Adrenal insufficiency (AI) is rarely diagnosed in patients with HIV infection, in spite of autopsy studies showing very high rates of adrenal involvement. This study was aimed to determine the presence, patterns and predictors of AI in patients with HIV infection. Methods: : Consecutive HIV patients, 18-70 yr age, without any severe co-morbid state, having at least one-year follow up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays...
February 2018: Indian Journal of Medical Research
(no author information available yet)
No abstract text is available yet for this article.
June 1, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Thilinie D Bandaranayake, Onyema E Ogbuagu, Amit Mahajan, Alexander O Vortmeyer, Merceditas S Villanueva
Cryptococcus neoformans is a ubiquitous encapsulated environmental yeast that can cause severe central nervous system disease, primarily in immune compromised hosts. In patients with AIDS, the spectrum of cryptococcal central nervous system disease includes meningitis, cystic lesions, and mass-like cryptococcomas. We report a fatal case of meningitis and cerebritis caused by C. neoformans in an AIDS patient refractory to multiple courses of liposomal amphotericin B despite immune recovery with antiretroviral therapy...
January 1, 2018: International Journal of STD & AIDS
Hong-Van Tieu, Barbara S Taylor, Joyce Jones, Timothy J Wilkin
The 2018 Conference on Retroviruses and Opportunistic Infections (CROI) showcased exciting data on new investigational agents including MK-8591 and tri-specific antibody targeting 3 highly conserved epitopes on HIV-1 in a single antibody. Clinical trials of initial antiretroviral therapy (ART) and switch studies involving bictegravir/emtricitabine/tenofovir alafenamide were presented. Intensification of initial ART with integrase strand transfer inhibitors did not increase the risk of immune reconstitution inflammatory syndrome...
May 2018: Topics in Antiviral Medicine
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