Central nervous system immune reconstitution inflammatory syndrome in AIDS: experience of a Mexican neurological centre.
BACKGROUND
Highly active antiretroviral therapy (HAART) restores the inflammatory immune response in AIDS patients and it may unmask previous subclinical infections or paradoxically exacerbate symptoms of opportunistic infections. Up to 25% of patients receiving HAART develop immune reconstitution inflammatory syndrome (IRIS). We describe six patients with IRIS central nervous system (CNSIRIS) manifestations emphasizing the relevance of CSF cultures and neuroimaging in early diagnosis and management.


METHODS
Patients with CNSIRIS were identified among hospitalized HIV-infected patients that started HAART from January 2002 through December 2007 at a referral neurological center in Mexico.


RESULTS
One-hundred and forty-two HIV-infected patients with neurological signs were hospitalized, 64 of which had received HAART, and six (9.3%) developed CNSIRIS. Five patients were male. Two cases of tuberculosis, two of cryptococcosis, one of brain toxoplasmosis, and one possible PML case were found. IRIS onset occurred within 12 weeks of HAART in five patients. Anti-infective therapy was continued. In one case, HAART was temporarily suspended. In long-term follow-up the clinical condition improved in all patients.


CONCLUSIONS
CNSIRIS associated to opportunistic infections appeared in 9% of patients receiving HAART. Interestingly, no cases of malignancy or neoplasm IRIS-related were found. Frequent clinical assessment and neuroimaging studies supported diagnosis and treatment. Risk factors were similar to those found in other series.
Department of Neurology, Instituto Nacional de Ciencias Neurológicas, Jr. Ancash 1271, Barrios Altos, Lima 1, Peru. erikguevara@hotmail.com
Erik A
EA
Guevara-Silva
María A
MA
Ramírez-Crescencio
José Luís
JL
Soto-Hernández
Graciela
G
Cárdenas
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000628:therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000628:therapy*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D002493:Central Nervous System Diseases / Q000209:etiology / Q000628:therapy*; D003453:Cryptococcosis / Q000134:cerebrospinal fluid / Q000209:etiology / Q000382:microbiology; D003455:Cryptococcus neoformans; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology / Q000628:therapy*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000134:cerebrospinal fluid / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008800:Mexico; D009169:Mycobacterium tuberculosis; D059906:Neuroimaging; D012189:Retrospective Studies; D014123:Toxoplasmosis / Q000134:cerebrospinal fluid / Q000209:etiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000134:cerebrospinal fluid / Q000209:etiology / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents