Paucity of Initial Cerebrospinal Fluid Inflammation in Cryptococcal Meningitis Is Associated with Subsequent Immune Reconstitution Inflammatory Syndrome
Paucity of Initial Cerebrospinal Fluid Inflammation in Cryptococcal Meningitis Is Associated with Subsequent Immune Reconstitution Inflammatory Syndrome
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DOI：
10.1086/655785
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发表时间：
2010-09-15
影响因子：
6.4
通讯作者：
Bohjanen, Paul R.
中科院分区：
文献类型：
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作者：
Boulware, David R.;Bonham, Shulamith C.;Bohjanen, Paul R.
背景隐球菌脑膜炎（CM）相关的免疫重建炎症综合征（IRIS）使20%-40%的艾滋病和既往CM的抗逆转录病毒治疗（ART）初治者的ART复杂化。发病机制是未知的。我们比较了初次接受抗逆转录病毒治疗的艾滋病患者的初始脑脊液（CSF）培养、炎症标志物和细胞因子谱，这些患者在开始抗逆转录病毒治疗后发生或未发生IRIS。我们还比较了IRIS事件或CM复发时的结果。在85例CM受试者中，33例（39%）发生了CM相关IRIS，5例（6%）发生了培养阳性CM复发。在CM诊断时，与未发生IRIS的受试者相比，随后发生IRIS的受试者炎症较少，CSF白细胞、蛋白质、干扰素-γ、白细胞介素-6、白细胞介素-8和肿瘤坏死因子-α减少（P
Background. Cryptococcal meningitis (CM)-related immune reconstitution inflammatory syndrome (IRIS) complicates antiretroviral therapy (ART) in 20%-40% of ART-naive persons with AIDS and prior CM. Pathogenesis is unknown.Methods. We compared initial cerebrospinal fluid (CSF) cultures, inflammatory markers, and cytokine profiles in ART-naive patients with AIDS who did or did not subsequently develop IRIS after starting ART. We also compared results obtained at IRIS events or CM relapse.Results. Of 85 subjects with CM, 33 (39%) developed CM-related IRIS and 5 (6%) developed culture-positive CM relapse. At CM diagnosis, subjects subsequently developing IRIS had less inflammation, with decreased CSF leukocytes, protein, interferon-gamma, interleukin-6, interleukin-8, and tumor necrosis factor-alpha, compared with subjects not developing IRIS (P