Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era

被引:36
作者
Manzardo, Christian [1 ]
del Mar Ortega, Maria [1 ]
Sued, Omar [1 ]
Garcia, Felipe [1 ]
Moreno, Asuncion [1 ]
Miro, Jose M. [1 ]
机构
[1] Univ Barcelona, Hosp Clin Barcelona, Infect Dis Serv, Inst Invest Biomed August Pi I Sunyer, E-08036 Barcelona, Spain
关键词
AIDS; central nervous system (CNS); HAART; HIV; immune reconstitution inflammatory syndrome (IRIS); opportunistic infections; toxoplasmosis; PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY; CRYPTOCOCCAL MENINGITIS; NEUROLOGICAL COMPLICATIONS; MAINTENANCE THERAPY; AIDS PATIENTS; HIV; DIAGNOSIS; DISEASE; DISCONTINUATION; TUBERCULOSIS;
D O I
10.1080/13550280500513846
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
A marked decrease in incidence has been observed for most central nervous system (CNS) opportunistic infections (OIs) after the use of highly active antiretroviral therapy (HAART) in developed countries. However, the spectrum of these OIs in acquired immunodeficiency syndrome (AIDS) patients has remained almost unchanged. CNS toxoplasmosis, cryptococcosis, tuberculosis, and progressive multifocal leukoencephalopathy (PML) remain the most frequent ones. Primary CNS lymphoma should be included in the differential diagnosis of all cases with focal lesions. Final diagnosis is currently made by combining neuroimaging techniques (single-photon emission computed tomography [SPECT], positron emission tomography [PET], magnetic resonance imaging [MRI] and/or computed tomography [CT] scan) and molecular studies of cerebrospinal fluid (CSF) and therapeutical response. Stereotactic biopsy should only be performed in the case of atypical lesions or nonresponse to recommended treatments. After treatment of the acute phase, lifelong maintenance therapy is necessary to prevent OI recurrences. Once HAART is initiated, some patients can develop a clinical worsening of some CNS Ols with or without atypical neuroimaging manifestations. This paradoxical worsening is known as the immune reconstitution inflammatory syndrome (IRIS) and it results from reconstitution of the immune system's ability to recognize pathogens/antigens in patients with prior Ols and low CD4+ T-cell counts. In this context, IRIS can be seen in patients with CNS cryptococcosis, tuberculosis, or PML. On the other hand, HAART-induced immune reconstitution can improve the prognosis of some untreatable diseases such as PML, and can allow maintenance therapy of some CNS OI to be safely discontinued in patients with high and sustained CD4+ T-cell response.
引用
收藏
页码:72 / 82
页数:11
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