PMID- 16540449
OWN - NLM
STAT- MEDLINE
DCOM- 20060714
LR  - 20220316
IS  - 1355-0284 (Print)
IS  - 1355-0284 (Linking)
VI  - 11 Suppl 3
DP  - 2005
TI  - Central nervous system immune reconstitution disease in acquired immunodeficiency 
      syndrome patients receiving highly active antiretroviral treatment.
PG  - 16-22
AB  - Highly active antiretroviral therapy (HAART)-induced immune restoration has been 
      very beneficial for acquired immunodeficiency syndrome (AIDS) patients. In rare 
      instances, HAART may induce a paradoxical clinical deterioration due to an immune 
      reconstitution inflammatory syndrome (IRIS). This syndrome has been described 
      with a wide variety of systemic infections and, in the central nervous system, 
      with Cryptococcus neoformans infection, cytomegalovirus retinitis, and 
      progressive multifocal leukoencephalopathy (PML). The authors have examined brain 
      tissue in eight cases of IRIS: two autopsy cases and three biopsy cases of HIV 
      encephalitis with IRIS and one autopsy case and two biopsy cases of PML with 
      IRIS. All the patients presented with clinical deterioration following initiation 
      of HAART and imaging showed contrast enhancement of the lesions. The symptoms 
      regressed in four patients whereas the other four patients died. 
      Neuropathological examination revealed severe inflammatory and demyelinating 
      lesions with marked intraparenchymal and perivascular infiltration by macrophages 
      and T lymphocytes. In some cases abundant viral proliferation was identified by 
      immunocytochemistry or in situ hybridization, but in others the infectious agent 
      could only be detected using PCR. T lymphocytes were predominantly CD8(+). In 
      those cases with the more favorable course, inflammation was less severe with 
      marked macrophage activation and a number of CD4(+) lymphocytes; in contrast, in 
      the lethal cases inflammation was severe and mostly composed of CD8(+) cytotoxic 
      lymphocytes. We conclude that HAART-induced paradoxical aggravation of HIV 
      encephalitis or AIDS-related PML due to IRIS is reversible in most cases but may 
      be lethal in others. In fatal cases, fulminant viral infection and/or acute 
      perivenous leukoencephalitis may result from a dysregulation of the CD8(+)/CD4(+) 
      T-cell balance.
FAU - Gray, Francoise
AU  - Gray F
AD  - Service Central d'Anatomie et de Cytologie Pathologiques, AP-HP, Hopital 
      Lariboisiere, France. francoise.gray@lrb.aphp.fr
FAU - Bazille, Celine
AU  - Bazille C
FAU - Adle-Biassette, Homa
AU  - Adle-Biassette H
FAU - Mikol, Jacqueline
AU  - Mikol J
FAU - Moulignier, Antoine
AU  - Moulignier A
FAU - Scaravilli, Francesco
AU  - Scaravilli F
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Neurovirol
JT  - Journal of neurovirology
JID - 9508123
SB  - IM
MH  - Acquired Immunodeficiency Syndrome/*drug therapy
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - Encephalitis/*etiology/immunology/virology
MH  - Humans
MH  - Immunohistochemistry
MH  - In Situ Hybridization
MH  - Inflammation/*etiology
MH  - Leukoencephalopathy, Progressive Multifocal/*etiology/immunology
MH  - Macrophages/immunology
MH  - T-Lymphocytes/immunology
RF  - 20
EDAT- 2006/03/17 09:00
MHDA- 2006/07/15 09:00
CRDT- 2006/03/17 09:00
PHST- 2006/03/17 09:00 [pubmed]
PHST- 2006/07/15 09:00 [medline]
PHST- 2006/03/17 09:00 [entrez]
AID - WV40JT33661W0535 [pii]
AID - 10.1080/13550280500511741 [doi]
PST - ppublish
SO  - J Neurovirol. 2005;11 Suppl 3:16-22. doi: 10.1080/13550280500511741.