PMID- 15145720
OWN - NLM
STAT- MEDLINE
DCOM- 20040719
LR  - 20161124
IS  - 0009-9260 (Print)
IS  - 0009-9260 (Linking)
VI  - 59
IP  - 6
DP  - 2004 Jun
TI  - Immune reconstitution inflammatory syndrome in HIV-infected patients with 
      mycobacterial infections starting highly active anti-retroviral therapy.
PG  - 505-13
AB  - AIM: To describe the radiological appearances of immune reconstitution 
      inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected 
      patients with mycobacterial infections starting highly active anti-retroviral 
      therapy (HAART). MATERIALS AND METHODS: Five consecutive HIV infected patients 
      with IRIS due to mycobacterial infection were studied. Intercurrent infection and 
      poor drug compliance were excluded as causes of presentation. The chest 
      radiological appearances at the time of starting HAART and at the time of 
      diagnosis of IRIS were compared. RESULTS: In these five patients there was 
      clinical and radiological deterioration, occurring between 10 days and 7 months 
      after starting HAART, leading to unmasking of previously undiagnosed 
      mycobacterial infection or to worsening of mycobacterial disease. All five 
      patients had HAART-induced increases in CD4+ T lymphocyte counts and reductions 
      in peripheral blood HIV "viral load". Chest radiographic abnormalities due to 
      IRIS included marked mediastinal lymphadenopathy in three patients-severe enough 
      to produce tracheal compression in two patients (one of whom had stridor)-and was 
      associated with new pulmonary infiltrates in two patients. The other two patients 
      had new infiltrates, which in one patient was associated with a pleural effusion. 
      CONCLUSION: These cases illustrate the diverse chest radiographic appearances of 
      IRIS occurring after HAART in patients with mycobacterial and HIV co-infection. 
      Marked mediastinal lymphadenopathy occurred in three of these five patients (with 
      associated tracheal narrowing in two patients); four patients developed pulmonary 
      infiltrates and one had an effusion. The cases further highlight that the onset 
      of IRIS may be delayed for several months after HAART is started.
FAU - Buckingham, S J
AU  - Buckingham SJ
AD  - Department of Imaging, University College London Hospitals NHS Trust, London, UK.
FAU - Haddow, L J
AU  - Haddow LJ
FAU - Shaw, P J
AU  - Shaw PJ
FAU - Miller, R F
AU  - Miller RF
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Clin Radiol
JT  - Clinical radiology
JID - 1306016
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*diagnostic imaging/immunology
MH  - Antiretroviral Therapy, Highly Active/*adverse effects/methods
MH  - CD4 Lymphocyte Count
MH  - HIV Infections/*drug therapy/immunology
MH  - Humans
MH  - Immunity, Cellular
MH  - Mycobacterium tuberculosis
MH  - Systemic Inflammatory Response Syndrome/*diagnostic imaging/immunology/virology
MH  - Tomography, X-Ray Computed/methods
MH  - Tuberculosis, Pulmonary/*diagnostic imaging/immunology
EDAT- 2004/05/18 05:00
MHDA- 2004/07/20 05:00
CRDT- 2004/05/18 05:00
PHST- 2003/07/29 00:00 [received]
PHST- 2003/11/24 00:00 [revised]
PHST- 2003/12/03 00:00 [accepted]
PHST- 2004/05/18 05:00 [pubmed]
PHST- 2004/07/20 05:00 [medline]
PHST- 2004/05/18 05:00 [entrez]
AID - S0009926004000078 [pii]
AID - 10.1016/j.crad.2003.12.002 [doi]
PST - ppublish
SO  - Clin Radiol. 2004 Jun;59(6):505-13. doi: 10.1016/j.crad.2003.12.002.