PMID- 16540459
OWN - NLM
STAT- MEDLINE
DCOM- 20060714
LR  - 20061115
IS  - 1355-0284 (Print)
IS  - 1355-0284 (Linking)
VI  - 11 Suppl 3
DP  - 2005
TI  - Central nervous system opportunistic infections in developed countries in the 
      highly active antiretroviral therapy era.
PG  - 72-82
AB  - A marked decrease in incidence has been observed for most central nervous system 
      (CNS) opportunistic infections (OIs) after the use of highly active 
      antiretroviral therapy (HAART) in developed countries. However, the spectrum of 
      these OIs in acquired immunodeficiency syndrome (AIDS) patients has remained 
      almost unchanged. CNS toxoplasmosis, cryptococcosis, tuberculosis, and 
      progressive multifocal leukoencephalopathy (PML) remain the most frequent ones. 
      Primary CNS lymphoma should be included in the differential diagnosis of all 
      cases with focal lesions. Final diagnosis is currently made by combining 
      neuroimaging techniques (single-photon emission computed tomography [SPECT], 
      positron emission tomography [PET], magnetic resonance imaging [MRI] and/or 
      computed tomography [CT] scan) and molecular studies of cerebrospinal fluid (CSF) 
      and therapeutical response. Stereotactic biopsy should only be performed in the 
      case of atypical lesions or nonresponse to recommended treatments. After 
      treatment of the acute phase, lifelong maintenance therapy is necessary to 
      prevent OI recurrences. Once HAART is initiated, some patients can develop a 
      clinical worsening of some CNS OIs with or without atypical neuroimaging 
      manifestations. This paradoxical worsening is known as the immune reconstitution 
      inflammatory syndrome (IRIS) and it results from reconstitution of the immune 
      system's ability to recognize pathogens/antigens in patients with prior OIs and 
      low CD4+ T-cell counts. In this context, IRIS can be seen in patients with CNS 
      cryptococcosis, tuberculosis, or PML. On the other hand, HAART-induced immune 
      reconstitution can improve the prognosis of some untreatable diseases such as 
      PML, and can allow maintenance therapy of some CNS OI to be safely discontinued 
      in patients with high and sustained CD4+ T-cell response.
FAU - Manzardo, Christian
AU  - Manzardo C
AD  - Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions 
      Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
FAU - Del Mar Ortega, Maria
AU  - Del Mar Ortega M
FAU - Sued, Omar
AU  - Sued O
FAU - Garcia, Felipe
AU  - Garcia F
FAU - Moreno, Asuncion
AU  - Moreno A
FAU - Miro, Jose M
AU  - Miro JM
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - J Neurovirol
JT  - Journal of neurovirology
JID - 9508123
SB  - IM
MH  - AIDS-Related Opportunistic Infections/diagnosis/epidemiology/*etiology
MH  - *Antiretroviral Therapy, Highly Active
MH  - Central Nervous System Infections/diagnosis/epidemiology/*etiology/microbiology
MH  - Developed Countries
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
RF  - 44
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 - N761Q03024X421R7 [pii]
AID - 10.1080/13550280500513846 [doi]
PST - ppublish
SO  - J Neurovirol. 2005;11 Suppl 3:72-82. doi: 10.1080/13550280500513846.