Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions


Haddow, LJ; Colebunders, R; Meintjes, G; Lawn, SD; Elliott, JH; Manabe, YC; Bohjanen, PR; Sungkanuparph, S; Easterbrook, PJ; French, MA; Boulware, DR; (2010) Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. The Lancet infectious diseases, 10 (11). pp. 791-802. ISSN 1473-3099 DOI: https://doi.org/10.1016/S1473-3099(10)70170-5

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Abstract

Cryptococcal immune reconstitution inflammatory syndrome (IRIS) may present as a clinical worsening or new presentation of cryptococcal disease after initiation of antiretroviral therapy (ART), and is thought to be caused by recovery of cryptococcus-specific immune responses. We have reviewed reports of cryptococcal IRIS and have developed a consensus case definition specifically for paradoxical crytopcoccal IRIS in patients with HIV-1 and known cryptococcal disease before ART, and a separate definition for incident cryptococcosis developed during ART (termed ART-associated cryptococcosis), for which a proportion of cases are likely to be unmasking cryptococcal IRIS. These structured case definitions are intended to aid design of future clinical, epidemiological, and immunopathological studies of cryptococcal IRIS, to standardise diagnostic criteria, and to facilitate comparisons between studies. As for definitions of tuberculosis-associated IRIS, definitions for cryptococcal IRIS should be regarded as preliminary until further insights into the immunopathology of IRIS permit their refinement.

Item Type: Article
Keywords: ACTIVE ANTIRETROVIRAL THERAPY, ACQUIRED-IMMUNODEFICIENCY-SYNDROME, HIV-INFECTED PATIENTS, HIGH-DOSE FLUCONAZOLE, INCREASED, INTRACRANIAL-PRESSURE, RISK-FACTORS, SOUTH-AFRICA, OPPORTUNISTIC, INFECTIONS, AMPHOTERICIN-B, NEOFORMANS INFECTION, Anti-HIV Agents, administration & dosage, adverse effects, Cryptococcosis, diagnosis, microbiology, pathology, Cryptococcus, immunology, isolation & purification, HIV Infections, complications, drug therapy, virology, HIV-1, isolation & purification, Humans, Immune Reconstitution Inflammatory Syndrome, diagnosis, microbiology, pathology
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 21029993
Web of Science ID: 283912800025
URI: http://researchonline.lshtm.ac.uk/id/eprint/2066

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