Guevara-Silva Erik A, Ramírez-Crescencio María A, Soto-Hernández José Luís, Cárdenas Graciela
Department of Neurology, Instituto Nacional de Ciencias Neurológicas, Jr. Ancash 1271, Barrios Altos, Lima 1, Peru.
Clin Neurol Neurosurg. 2012 Sep;114(7):852-61. doi: 10.1016/j.clineuro.2012.01.020. Epub 2012 Feb 10.
Highly active antiretroviral therapy (HAART) restores the inflammatory immune response in AIDS patients and it may unmask previous subclinical infections or paradoxically exacerbate symptoms of opportunistic infections. Up to 25% of patients receiving HAART develop immune reconstitution inflammatory syndrome (IRIS). We describe six patients with IRIS central nervous system (CNSIRIS) manifestations emphasizing the relevance of CSF cultures and neuroimaging in early diagnosis and management.
Patients with CNSIRIS were identified among hospitalized HIV-infected patients that started HAART from January 2002 through December 2007 at a referral neurological center in Mexico.
One-hundred and forty-two HIV-infected patients with neurological signs were hospitalized, 64 of which had received HAART, and six (9.3%) developed CNSIRIS. Five patients were male. Two cases of tuberculosis, two of cryptococcosis, one of brain toxoplasmosis, and one possible PML case were found. IRIS onset occurred within 12 weeks of HAART in five patients. Anti-infective therapy was continued. In one case, HAART was temporarily suspended. In long-term follow-up the clinical condition improved in all patients.
CNSIRIS associated to opportunistic infections appeared in 9% of patients receiving HAART. Interestingly, no cases of malignancy or neoplasm IRIS-related were found. Frequent clinical assessment and neuroimaging studies supported diagnosis and treatment. Risk factors were similar to those found in other series.
高效抗逆转录病毒疗法（HAART）可恢复艾滋病患者的炎症免疫反应，可能会使先前的亚临床感染显现出来，或者反常地加剧机会性感染的症状。接受HAART治疗的患者中，高达25%会发生免疫重建炎症综合征（IRIS）。我们描述了6例有IRIS中枢神经系统（CNSIRIS）表现的患者，强调脑脊液培养和神经影像学在早期诊断和管理中的相关性。
在2002年1月至2007年12月期间于墨西哥一家转诊神经中心开始接受HAART治疗的住院HIV感染患者中识别出CNSIRIS患者。
142例有神经体征的HIV感染患者住院，其中64例接受了HAART治疗，6例（9.3%）发生了CNSIRIS。5例为男性。发现2例结核病、2例隐球菌病、1例脑弓形虫病和1例可能的进行性多灶性白质脑病（PML）病例。5例患者在HAART治疗12周内出现IRIS。继续进行抗感染治疗。1例患者暂时停用了HAART。在长期随访中，所有患者的临床状况均有改善。
接受HAART治疗的患者中，9%出现了与机会性感染相关的CNSIRIS。有趣的是，未发现与恶性肿瘤或肿瘤相关的IRIS病例。频繁的临床评估和神经影像学研究有助于诊断和治疗。危险因素与其他系列研究中发现的相似。
