PMID- 22326129
OWN - NLM
STAT- MEDLINE
DCOM- 20121130
LR  - 20120724
IS  - 1872-6968 (Electronic)
IS  - 0303-8467 (Linking)
VI  - 114
IP  - 7
DP  - 2012 Sep
TI  - Central nervous system immune reconstitution inflammatory syndrome in AIDS: 
      experience of a Mexican neurological centre.
PG  - 852-61
LID - 10.1016/j.clineuro.2012.01.020 [doi]
AB  - 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.
CI  - Copyright (c) 2012 Elsevier B.V. All rights reserved.
FAU - Guevara-Silva, Erik A
AU  - Guevara-Silva EA
AD  - Department of Neurology, Instituto Nacional de Ciencias Neurologicas, Jr. Ancash 
      1271, Barrios Altos, Lima 1, Peru. erikguevara@hotmail.com
FAU - Ramirez-Crescencio, Maria A
AU  - Ramirez-Crescencio MA
FAU - Soto-Hernandez, Jose Luis
AU  - Soto-Hernandez JL
FAU - Cardenas, Graciela
AU  - Cardenas G
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20120210
PL  - Netherlands
TA  - Clin Neurol Neurosurg
JT  - Clinical neurology and neurosurgery
JID - 7502039
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Antifungal Agents)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/epidemiology/therapy
MH  - Acquired Immunodeficiency Syndrome/complications/*therapy
MH  - Adult
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Antifungal Agents/therapeutic use
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - CD4 Lymphocyte Count
MH  - Central Nervous System Diseases/etiology/*therapy
MH  - Cryptococcosis/cerebrospinal fluid/etiology/microbiology
MH  - Cryptococcus neoformans
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/etiology/*therapy
MH  - Leukoencephalopathy, Progressive Multifocal/cerebrospinal fluid/etiology
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Mexico
MH  - Mycobacterium tuberculosis
MH  - Neuroimaging
MH  - Retrospective Studies
MH  - Toxoplasmosis/cerebrospinal fluid/etiology
MH  - Treatment Outcome
MH  - Tuberculosis/cerebrospinal fluid/etiology/microbiology
EDAT- 2012/02/14 06:00
MHDA- 2012/12/10 06:00
CRDT- 2012/02/14 06:00
PHST- 2010/01/08 00:00 [received]
PHST- 2011/11/21 00:00 [revised]
PHST- 2012/01/15 00:00 [accepted]
PHST- 2012/02/14 06:00 [entrez]
PHST- 2012/02/14 06:00 [pubmed]
PHST- 2012/12/10 06:00 [medline]
AID - S0303-8467(12)00034-0 [pii]
AID - 10.1016/j.clineuro.2012.01.020 [doi]
PST - ppublish
SO  - Clin Neurol Neurosurg. 2012 Sep;114(7):852-61. doi: 
      10.1016/j.clineuro.2012.01.020. Epub 2012 Feb 10.