HIV 相关进行性多灶性白质脑病的检查点抑制剂治疗的前景与挑战。
Promise and Challenges of Checkpoint Inhibitor Therapy for Progressive Multifocal Leukoencephalopathy in HIV.
机构信息
Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, 5C103, Bethesda, MD, 20892-1684, USA.
Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
出版信息
Curr HIV/AIDS Rep. 2022 Dec;19(6):580-591. doi: 10.1007/s11904-022-00626-w. Epub 2022 Oct 1.
PURPOSE OF REVIEW
Progressive multifocal leukoencephalopathy (PML) is a severe opportunistic infection that remains an important cause of morbidity and mortality in people living with HIV (PLWH). Immune checkpoint molecules are negative regulators of the immune response that have been targeted as a strategy to bolster anti-viral immunity in PML, with varied outcomes reported. While initiation and optimization of antiretroviral therapy remains the standard of care in HIV-related PML, the specific opportunities and risks for checkpoint blockade in these cases should be explored.
RECENT FINDINGS
As of April 15, 2022, only 5 of the 53 total published cases of PML treated with checkpoint blockade had underlying HIV infection; four of these had a favorable outcome. The risk of promoting immune reconstitution inflammatory syndrome is a major concern and underscores the importance of patient selection and monitoring. Checkpoint blockade warrants further exploration as a potentially promising option for treatment escalation in HIV-related PML.
目的综述
进行性多灶性白质脑病（PML）是一种严重的机会性感染，仍然是导致 HIV 感染者（PLWH）发病和死亡的重要原因。免疫检查点分子是免疫反应的负调节剂，已被作为增强 PML 抗病毒免疫的一种策略，但其结果存在差异。虽然启动和优化抗逆转录病毒治疗仍然是 HIV 相关 PML 的标准治疗方法，但在这些情况下，应该探讨检查点阻断的具体机会和风险。
最近的发现
截至 2022 年 4 月 15 日，在已发表的 53 例接受检查点阻断治疗的 PML 总病例中，仅有 5 例存在潜在的 HIV 感染；其中 4 例有良好的结局。促进免疫重建炎症综合征的风险是一个主要关注点，突出了患者选择和监测的重要性。检查点阻断值得进一步探索，作为 HIV 相关 PML 治疗升级的一种有前途的选择。
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