PMID- 30215671
OWN - NLM
STAT- MEDLINE
DCOM- 20200130
LR  - 20231005
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Print)
IS  - 1058-4838 (Linking)
VI  - 68
IP  - 2
DP  - 2019 Jan 7
TI  - Increased Metabolic Activity on 18F-Fluorodeoxyglucose Positron Emission 
      Tomography-Computed Tomography in Human Immunodeficiency Virus-Associated Immune 
      Reconstitution Inflammatory Syndrome.
PG  - 229-238
LID - 10.1093/cid/ciy454 [doi]
AB  - BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) represents an 
      unexpected inflammatory response shortly after initiation of antiretroviral 
      therapy (ART) in some human immunodeficiency virus (HIV)-infected patients with 
      underlying neoplasia or opportunistic infections, including tuberculosis. We 
      hypothesized that IRIS is associated with increased glycolysis and that 
      18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography 
      (PET/CT) could help identify high-risk subjects. METHODS: In this prospective 
      cohort study, 30 HIV-infected patients (CD4+ count <100 cells/microL) underwent 
      FDG-PET/CT scans at baseline and 4-8 weeks after ART initiation. Ten patients 
      developed IRIS (6 mycobacterial). RESULTS: At baseline, total glycolytic 
      activity, total lesion volume, and maximum standardized uptake values (SUVs) of 
      pathologic FDG uptake (reflective of opportunistic disease burden) were 
      significantly higher in IRIS vs non-IRIS (P = .010, .017, and .029, respectively) 
      and significantly correlated with soluble inflammatory biomarkers (interferon-gamma, 
      myeloperoxidase, tumor necrosis factor, interleukin 6, soluble CD14). Baseline 
      bone marrow (BM) and spleen FDG uptake was higher in mycobacterial IRIS 
      specifically. After ART initiation, BM and spleen mean SUV decreased in non-IRIS 
      (P = .004, .013) but not IRIS subjects. Our results were supported by 
      significantly higher glucose transporter 1 (Glut-1) expression of CD4+ cells and 
      monocytes after ART initiation in IRIS/mycobacterial IRIS compared with non-IRIS 
      patients. CONCLUSIONS: We conclude that increased pathologic metabolic activity 
      on FDG-PET/CT prior to ART initiation is associated with IRIS development and 
      correlates with inflammatory biomarkers. Abnormally elevated BM and spleen 
      metabolism is associated with mycobacterial IRIS, HIV viremia, and Glut-1 
      expression on CD4+ cells and monocytes. CLINICAL TRIALS REGISTRATION: 
      NCT02147405.
FAU - Hammoud, Dima A
AU  - Hammoud DA
AD  - Center for Infectious Diseases Imaging, Clinical Center, National Institutes of 
      Health (NIH).
FAU - Boulougoura, Afroditi
AU  - Boulougoura A
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Papadakis, Georgios Z
AU  - Papadakis GZ
AD  - Center for Infectious Diseases Imaging, Clinical Center, National Institutes of 
      Health (NIH).
FAU - Wang, Jing
AU  - Wang J
AD  - Clinical Research Directorate/Clinical Monitoring Research Program, Leidos 
      Biomedical Research, Inc, National Cancer Institute, Frederick.
FAU - Dodd, Lori E
AU  - Dodd LE
AD  - Biostatistics Research Branch, NIAID, NIH, Bethesda.
FAU - Rupert, Adam
AU  - Rupert A
AD  - Leidos Biomedical Research Inc, Frederick National Laboratory for Cancer 
      Research.
FAU - Higgins, Jeanette
AU  - Higgins J
AD  - Leidos Biomedical Research Inc, Frederick National Laboratory for Cancer 
      Research.
FAU - Roby, Gregg
AU  - Roby G
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Metzger, Dorinda
AU  - Metzger D
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Laidlaw, Elizabeth
AU  - Laidlaw E
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Mican, JoAnn M
AU  - Mican JM
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Pau, Alice
AU  - Pau A
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Lage, Silvia
AU  - Lage S
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Wong, Chun-Shu
AU  - Wong CS
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Lisco, Andrea
AU  - Lisco A
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Manion, Maura
AU  - Manion M
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Sheikh, Virginia
AU  - Sheikh V
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
FAU - Millo, Corina
AU  - Millo C
AD  - Positron Emission Tomography Department, Clinical Center, NIH, Bethesda, 
      Maryland.
FAU - Sereti, Irini
AU  - Sereti I
AD  - Division of Intramural Research, National Institute of Allergy and Infectious 
      Diseases (NIAID), NIH, Bethesda.
LA  - eng
SI  - ClinicalTrials.gov/NCT02147405
GR  - HHSN261200800001C/RC/CCR NIH HHS/United States
GR  - HHSN261200800001E/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, N.I.H., Intramural
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Biomarkers)
RN  - 0 (Glucose Transporter Type 1)
RN  - 0 (Radiopharmaceuticals)
RN  - 0Z5B2CJX4D (Fluorodeoxyglucose F18)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/*adverse effects/therapeutic use
MH  - Biomarkers
MH  - Female
MH  - *Fluorodeoxyglucose F18
MH  - Gene Expression Regulation/drug effects
MH  - Glucose Transporter Type 1/genetics/metabolism
MH  - HIV Infections/*complications
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*diagnostic imaging/*metabolism
MH  - Male
MH  - Monocytes/metabolism
MH  - *Positron Emission Tomography Computed Tomography
MH  - Radiopharmaceuticals/pharmacology
MH  - T-Lymphocytes/metabolism
PMC - PMC6321853
EDAT- 2018/09/15 06:00
MHDA- 2020/01/31 06:00
PMCR- 2019/09/11
CRDT- 2018/09/15 06:00
PHST- 2018/03/03 00:00 [received]
PHST- 2018/05/23 00:00 [accepted]
PHST- 2018/09/15 06:00 [pubmed]
PHST- 2020/01/31 06:00 [medline]
PHST- 2018/09/15 06:00 [entrez]
PHST- 2019/09/11 00:00 [pmc-release]
AID - 5095310 [pii]
AID - ciy454 [pii]
AID - 10.1093/cid/ciy454 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2019 Jan 7;68(2):229-238. doi: 10.1093/cid/ciy454.