New HIV/AIDS co-infection research from St. George's University discussed
2009 JUL 13 - (NewsRx.com) -- "Prospective data on incidence, characteristics, and risk factors for cryptococcal meningitis immune reconstitution inflammatory syndrome (CM-IRIS) are lacking. Prospective study of 65 antiretroviral therapy (ART)-naive HIV-infected cryptococcal meningitis (CM) patients, who started ART after initiation of antifungal treatment," scientists in the United Kingdom report. "CM-IRIS definition: (1) cerebrospinal fluid (CSF) culture-confirmed CM, (2) symptom resolution before starting ART, (3) adherence to fluconazole and ART, (4) recurrence of CM symptoms after starting ART, (5) immunologic and/or virologic response to ART, (6) no alternative diagnosis. ART was started at a median of 47 days from CM diagnosis. CM-IRIS developed in 11 of 65 (17%), at a median 29 days from starting ART. No factors at first CM episode (fungal burden, rate of clearance, CSF, or HIV parameters) predicted those at risk of CM-IRIS. At 6 months on ART, IRIS patients had greater CD4 rise from baseline (220 vs. 124 x 10(6) cells/L in non-IRIS, P = 0.01), and 4 of 11 CM-IRIS patients died compared with 14 of 54 non-IRIS patients (P = 0.5). For those developing CM-IRIS, CSF proinflammatory cytokines interferon gamma, tumour necrosis factor alpha, and interleukin 6, did not differ between first CM and CM-IRIS episode. Patients with CM-IRIS had greater immune restoration in response to ART," wrote T. Bicanic and colleagues, St. George's University. The researchers concluded: "Although common and potentially fatal, larger prospective studies are needed to determine whether CM-IRIS, in patients treated initially with amphotericin B, is associated with any increase in overall mortality.." Bicanic and colleagues published their study in Jaids - Journal of Acquired Immune Deficiency Syndromes (Immune Reconstitution Inflammatory Syndrome in HIV-Associated Cryptococcal Meningitis: A Prospective Study. Jaids - Journal of Acquired Immune Deficiency Syndromes, 2009;51(2):130-134). For more information, contact T. Bicanic, St. George's University London, Dept. of Cellular & Molecular Medical, Division Infectious Disease, London SW17 ORE, UK. Publisher contact information for the Jaids - Journal of Acquired Immune Deficiency Syndromes is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA. Keywords: United Kingdom, HIV/AIDS Co-Infection, AIDS, Acquired Immune Deficiency Syndrome, Acquired Immunodeficiency Syndrome, Antifungals, Antivirals, Biotechnology Business, Biotechnology Company, Central Nervous System Disease, Clinical Trial Research, Cryptococcal Meningitis, Drugs, Fluconazole, HIV, Human Immunodeficiency Virus Fungal Infection, Immunology, Meningitis, Pharmaceuticals, Sexually Transmitted Disease, Therapy, Treatment, ViroLogic Inc., Virology, St. George's University. This article was prepared by AIDS Weekly editors from staff and other reports. Copyright 2009, AIDS Weekly via NewsRx.com.
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