Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions - 12/12/13

Doi : 10.1016/S1473-3099(10)70170-5

Lewis J Haddow, PhD ^a,^b, Robert Colebunders, ProfPhD ^c,^d, Graeme Meintjes, MBChB ^e, Stephen D Lawn, MD ^f,^g, Julian H Elliott, PhD ^h,ⁱ, Yukari C Manabe, MD ^j,^k, Paul R Bohjanen, ProfPhD ^l, Somnuek Sungkanuparph, MD ^m, Philippa J Easterbrook, FRCP ^a,^b, Martyn A French, ProfMD ^n,^o, David R Boulware, DrMD ^l,^⁎

on behalf of the International Network for the Study of HIV-associated IRIS (INSHI)

^a Division of Immunology, Infection and Inflammatory Disease, King’s College London, London, UK

^b Department of Infectious Diseases, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

^c Institute of Tropical Medicine, Antwerp, Belgium

^d University of Antwerp, Antwerp, Belgium

^e Department of Medicine, Infectious Diseases Unit, GF Jooste Hospital, University of Cape Town, South Africa

^f Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

^g Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

^h Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia

ⁱ Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia

^j Infectious Diseases Institute, Makerere University School of Medicine, Kampala Uganda

^k Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

^l Center for Infectious Diseases and Microbiology Translational Research, and Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

^m Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

ⁿ School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia

^o Department of Clinical Immunology, Royal Perth Hospital and PathWest Laboratory Medicine, Perth, Australia

^* Correspondence to: Dr David Boulware, Division of Infectious Diseases, McGuire Translational Research Facility, University of Minnesota, 2001 6th Street SE, Minneapolis, MN 55455, USA

Summary

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.

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Plan

Introduction

Classification and terminology

Paradoxical cryptococcal IRIS

ART-associated cryptococcosis

Proposed case definitions for cryptococcal IRIS

Paradoxical cryptococcal IRIS

ART-associated cryptococcosis

Prevention and management

Assessment of case definitions

Search strategy and selection criteria

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Vol 10 - N° 11

P. 791-802 - novembre 2010 Retour au numéro

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Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions - 12/12/13

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