Immune reconstitution inflammatory syndrome and the central nervous system

Tory Johnson, Avindra Nath

Research output: Contribution to journalArticle

Abstract

Purpose of Review: Central nervous system-immune reconstitution inflammatory syndrome (CNS-IRIS) is a recently recognized, devastating, T-cell-mediated encephalitis that occurs in the setting of treatment of HIV infection or autoimmune diseases, the management of which remains challenging. We review the pathophysiology, the clinical subtypes and present guidelines for prevention, diagnosis and treatment of this entity. Recent Findings: Nearly all patients with multiple sclerosis who develop progressive multifocal leukoencephalopathy (PML) following treatment with natalizumab develop IRIS which carries a high morbidity and mortality rate. Chronic lymphocyte activation is commonly present in the CNS of HIV-infected patients despite adequate treatment with antiretroviral therapy (ART), suggesting that a chronic from of CNS-IRIS may contribute to the neurocognitive impairment in this population. Summary: The risk for CNS-IRIS can be decreased by starting ART early in the course of the illness or by reducing antigenic burden with antimicrobial treatment for opportunistic infections prior to starting ART. Of all the forms of CNS-IRIS, the management of IRIS associated with PML due to JC virus infection remains the most challenging, as no antimicrobial drug against this virus is available and the treatment of IRIS requires the use of corticosteroids, which impair the immune cells needed to control the infection.

Original languageEnglish (US)
Pages (from-to)284-290
Number of pages7
JournalCurrent Opinion in Neurology
Volume24
Issue number3
DOIs
StatePublished - Jun 2011

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Immune Reconstitution Inflammatory Syndrome
Central Nervous System
Progressive Multifocal Leukoencephalopathy
Therapeutics
JC Virus
Opportunistic Infections
Virus Diseases
Encephalitis
Lymphocyte Activation
Infection Control
Disease Management
Autoimmune Diseases
Multiple Sclerosis
HIV Infections
Adrenal Cortex Hormones
HIV
Guidelines
Viruses
Morbidity
T-Lymphocytes

Keywords

  • encephalitis
  • HIV dementia
  • HIV-associated neurocognitive disorders
  • immune restoration
  • multiple sclerosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Immune reconstitution inflammatory syndrome and the central nervous system. / Johnson, Tory; Nath, Avindra.

In: Current Opinion in Neurology, Vol. 24, No. 3, 06.2011, p. 284-290.

Research output: Contribution to journalArticle

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