Torok M Estee, Kambugu Andrew, Wright Edwina
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Curr Opin HIV AIDS. 2008 Jul;3(4):438-45. doi: 10.1097/COH.0b013e328302ebd1.
The purpose of this review is to examine the literature concerning immune reconstitution disease associated with the central nervous system infections.
Immune reconstitution disease is an adverse consequence of antiretroviral therapy, characterized by an aberrant immune response and presenting with new or worsening clinical symptoms and signs after initiation of antiretroviral therapy. Immune reconstitution disease may be associated with a broad spectrum of infectious pathogens, and has been described in the context of central nervous system infections, including progressive multifocal leucoencephalopathy, human herpesvirus infections, cryptococcal meningitis and tuberculous meningitis. Central nervous system immune reconstitution disease is a challenging condition as the clinical features are nonspecific, there is no agreed case definition, the immunopathogenesis is poorly understood, and the optimal treatment strategy is unknown. Central nervous system immune reconstitution disease appears to be associated with worse outcome than extracranial immune reconstitution disease.
Reports of central nervous system immune reconstitution disease are increasing and this trend is likely to continue as access to antiretroviral therapy improves in resource-limited settings in which many central nervous system infections are endemic. Considerable challenges remain in the prevention, diagnosis and management of these conditions.
本综述旨在研究与中枢神经系统感染相关的免疫重建疾病的文献。
免疫重建疾病是抗逆转录病毒治疗的一种不良后果，其特征为异常的免疫反应，在开始抗逆转录病毒治疗后出现新的或恶化的临床症状和体征。免疫重建疾病可能与多种感染病原体相关，并且已在中枢神经系统感染的背景下被描述，包括进行性多灶性白质脑病、人类疱疹病毒感染、隐球菌性脑膜炎和结核性脑膜炎。中枢神经系统免疫重建疾病是一种具有挑战性的病症，因为其临床特征不具特异性，尚无公认的病例定义，免疫发病机制了解甚少，且最佳治疗策略尚不清楚。中枢神经系统免疫重建疾病似乎比颅外免疫重建疾病的预后更差。
随着资源有限地区（许多中枢神经系统感染为地方病）抗逆转录病毒治疗的可及性提高，中枢神经系统免疫重建疾病的报告正在增加，且这一趋势可能会持续。在这些病症的预防、诊断和管理方面仍存在相当大的挑战。
