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Central Nervous System Immune Reconstitution Inflammatory Syndrome

  • Central Nervous System (J Lyons, Section Editor)
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Abstract

Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS) develops in 9 %–47 % of persons with HIV infection and a CNS opportunistic infection who start antiretroviral therapy and is associated with a mortality rate of 13 %–75 %. These rates vary according to the causative pathogen. Common CNS-IRIS events occur in relation to Cryptococcus, tuberculosis (TB), and JC virus, but several other mycobacteria, fungi, and viruses have been associated with IRIS. IRIS symptoms often mimic the original infection, and diagnosis necessitates consideration of treatment failure, microbial resistance, and an additional neurological infection. These diagnostic challenges often delay IRIS diagnosis and treatment. Corticosteroids have been used to treat CNS-IRIS, with variable responses; the best supportive evidence exists for the treatment of TB-IRIS. Pathogenic mechanisms vary: Cryptococcal IRIS is characterized by a paucity of cerebrospinal inflammation prior to antiretroviral therapy, whereas higher levels of inflammatory markers at baseline predispose to TB meningitis IRIS. This review focuses on advances in the understanding of CNS-IRIS over the past 2 years.

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Conflict of Interest

Suzaan Marais has received grant support for her institution from Wellcome Trust.

Nathan Bahr, David R Boulware, James Scriven, Robert J Wilkinson, and Graeme Meintjes declare no conflicts of interest.

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Authors and Affiliations

  1. Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, MTRF 3-222, 2001 6th Street SE, Minneapolis, MN, 55455, USA

    Nathan Bahr & David R. Boulware

  2. Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa

    Suzaan Marais, James Scriven, Robert J. Wilkinson & Graeme Meintjes

  3. Liverpool School of Tropical Medicine, Liverpool University, Liverpool, UK

    James Scriven

  4. Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa

    Suzaan Marais

  5. Department of Medicine, Imperial College London, London, W2 1PG, UK

    Robert J. Wilkinson & Graeme Meintjes

  6. Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa

    Robert J. Wilkinson & Graeme Meintjes

  7. National Institute of Medical Research, London, UK

    Robert J. Wilkinson

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  1. Nathan Bahr
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Correspondence to Nathan Bahr.

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Bahr, N., Boulware, D.R., Marais, S. et al. Central Nervous System Immune Reconstitution Inflammatory Syndrome. Curr Infect Dis Rep 15, 583–593 (2013). https://doi.org/10.1007/s11908-013-0378-5

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