Immune reconstitution disease of the central nervous system
No Thumbnail Available
Date
Journal Title
Journal ISSN
Volume Title
Publisher
Lippincott Williams & Wilkins
Abstract
Description
Purpose of review
The purpose of this review is to examine the literature concerning immune reconstitution
disease associated with the central nervous system infections.
Recent findings
Immune reconstitution disease is an adverse consequence of antiretroviral therapy,
characterized by an aberrant immune response and presenting with new or worsening
clinical symptoms and signs after initiation of antiretroviral therapy. Immune
reconstitution disease may be associated with a broad spectrum of infectious
pathogens, and has been described in the context of central nervous system infections,
including progressive multifocal leucoencephalopathy, human herpesvirus infections,
cryptococcal meningitis and tuberculous meningitis. Central nervous system immune
reconstitution disease is a challenging condition as the clinical features are nonspecific,
there is no agreed case definition, the immunopathogenesis is poorly understood, and
the optimal treatment strategy is unknown. Central nervous system immune
reconstitution disease appears to be associated with worse outcome than extracranial
immune reconstitution disease.
Summary
Reports of central nervous system immune reconstitution disease are increasing and
this trend is likely to continue as access to antiretroviral therapy improves in resourcelimited
settings in which many central nervous system infections are endemic.
Considerable challenges remain in the prevention, diagnosis and management of these
conditions.
Keywords
HIV/AIDS, antiretroviral therapy, central nervous system, opportunistic infections,
immune reconstitution disease, immune reconstitution inflammatory syndrome
Keywords
HIV/AIDS, Antiretroviral therapy, Central nervous system, Opportunistic infections, Immune reconstitution inflammatory syndrome, Immune reconstitution disease