Montelukast in the treatment of HIV associated immune reconstitution disease
Montelukast in the treatment of HIV associated immune reconstitution disease
复制标题
DOI：
10.1136/sti.2005.017863
复制
发表时间：
2006-12-01
影响因子：
3.6
通讯作者：
Lipman, M.
中科院分区：
文献类型：
--
作者：
Hardwick, C.;White, D.;Lipman, M.
免疫重建病（IRD）的发病机制尚不清楚，且难以控制，白三烯具有促炎作用，在先天免疫应答中起重要作用，在HIV感染中相对缺乏。孟鲁司特是一种白三烯受体拮抗剂（LTRA），目前被批准用于治疗哮喘。我们报道了三例严重的HIV相关IRD患者（病例1和2与HAART开始相关，对类固醇无反应），他们对孟鲁司特治疗获得了显著的临床反应。第一例为继发性梅毒的IRD，第二例和第三例为结核病。病例1和病例3均在暂时停用孟鲁司特后复发，并在重新开始时消退。在与HIV相关的IRD中，孟鲁司特应被视为类固醇的替代品，而类固醇无效。白三烯过度活跃可能与此有关。
The pathogenesis of immune recnstitution disease (IRD) is not well understood and it can be difficult to manage Leukotrienes exert proinflammatory effects, have an important role in the innate immune response, and are relatively deficient in HIV infection. Montelukast is a leukotriene receptor antagonist (LTRA) currently licensed for the treatment od asthma. We report a series of three patients with severe HIV associated IRD (cases 1 and 2 associated with starting HAART and unresponsive to steroids), who obtained clinically dramtic responses to treatment with montelukast. The first case is of IRD to secondary syphilis and the second and third to tuberculosis. Cases 1 and 3 both relapsed after a temporary break from montelukast and resolved on restarting. Montelukast should be considered in HIV associated IRD as an alternative to steroids and where these are not effective. Leukotriene overactivity may be implicated.