[Severe aseptic leucoencephalopathy.   Manifested as immune reconstitution inflammatory syndrome in Caucasian and African patients].
BACKGROUND
We hypothesize that CNS immune reconstitution inflammatory syndrome (IRIS) after highly active antiretroviral therapy (HAART) in HIV-1-positive patients may become manifest without any opportunistic infection as an aseptic leucoencephalopathy. This opens a window of opportunity for successful treatment with corticosteroids.


METHODS
We describe a case series of immunocompromised HIV-1-positive patients who were started on HAART. All of them had clinical laboratory follow-up tests and cerebral MRI in order to investigate the course and the underlying pathophysiology of this aseptic form of IRIS. One African patient died and we performed a neuropathological examination.


RESULTS
No infectious agent was detected before and during HAART. Three of four immunocompromised patients were successfully treated with corticosteroids while HAART was never interrupted and have survived up to now. One African patient died within 2 days despite intensive care due to cerebral oedema.


CONCLUSIONS
Starting HAART, HIV-1-positive patients may develop an aseptic type of IRIS of the CNS without any detectable opportunistic infection, a finding that has not yet been published. This makes them susceptible for successful treatment with corticosteroids. Perhaps IRIS has a higher incidence in African patients and the patients have a poorer outcome than Caucasians.
Ringelstein
A
A
Institut für Radiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf. a.ringelstein@gmx.de
Oelschlaeger
C
C
Arendt
G
G
Mathys
C
C
Dziewas
R
R
Niederstadt
T
T
Reichelt
D
D
Hasselblatt
M
M
Husstedt
I W
IW
Saleh
A
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D044383:Black People; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy / Q000276:immunology*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D044465:White People
D000305:Adrenal Cortex Hormones; D019380:Anti-HIV Agents