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隐球菌免疫重建炎症综合征:从血液和脑脊液生物标志物到治疗方法

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches.

作者信息

Brienze Vânia Maria Sabadoto, André Júlio César, Liso Elisabete, Louis Irina Vlasova-St

机构信息

Department of Neurological Sciences, Faculty of Medicine of São José do Rio Preto (FAMERP), São Paulo 15090000, Brazil.

Department of Molecular Biology, Faculty of Medicine of São José do Rio Preto (FAMERP), São Paulo 15090000, Brazil.

出版信息

Life (Basel). 2021 Jan 27;11(2):95. doi: 10.3390/life11020095.

Abstract

Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage human immunodeficiency virus (HIV) infection who have commenced antiretroviral treatments (ART). Virtually any opportunistic pathogen can provoke this type of immune restoration disorder. In this review, we focus on recent developments in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the prediction and diagnosis of cryptococcal meningitis IRIS (CM-IRIS). We assess current therapeutic regimens and novel treatment approaches to combat CM-IRIS. We discuss the utility of biomarkers for clinical monitoring and adjusting treatment modalities in acquired immunodeficiency syndrome (AIDS) patients co-infected with who have initiated ART.

摘要

免疫重建炎症综合征(IRIS)表现为一种过度的免疫反应,发生在晚期人类免疫缺陷病毒(HIV)感染且已开始抗逆转录病毒治疗(ART)的免疫功能低下患者免疫调节失衡的免疫恢复过程中。几乎任何机会性病原体都可引发这类免疫恢复紊乱。在本综述中,我们重点关注隐球菌性IRIS危险因素识别方面的最新进展以及我们对C-IRIS免疫发病机制认识的进步。我们概述血液和脑脊液中的新发现,这些发现可能有助于隐球菌性脑膜炎IRIS(CM-IRIS)的预测和诊断。我们评估对抗CM-IRIS的当前治疗方案和新的治疗方法。我们讨论生物标志物在开始ART的合并感染艾滋病患者临床监测和调整治疗方式中的作用。

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