Immune reconstitution inflammatory

Immune reconstitution inflammatory syndrome AIDS on HAART Acute or subacute Worsening or new neurological symptoms in the setting of immune reconstitution Immune mediated... 

Riedel DJ, Pardo CA et al (2006) Therapy Insight CNS manifestations of HIV-associated immune reconstitution inflammatory syndrome. Nat Clin Pract Neurol 2(10) 557-565 Rizzuto N, Cavallaro Tet al (1995) Role of HIV in the pathogenesis of distal symmetrical peripheral neuropathy. Acta Neuropathol 90(3) 244-250... 

Shelburne SA III, HamiU RJ (2003) The immune reconstitution inflammatory syndrome. AIDS Rev 5(2) 67-79... 

Venkataramana A, Pardo CA et al (2006) Immune reconstitution inflammatory syndrome in the CNS of HIV-infected patients. Neurology 67(3) 383-388 Verma A (2001) Epidemiology and clinical featmes of HIV-1 associated neuropathies. J Peripher Nerv Syst 6(1) 8-13... 

The immune reconstitution inflammatory syndrome (IRIS) has emerged as an important clinical issue in the management of HIV-infected individuals on ART. IRIS is characterized by paradoxical worsening of symptoms and signs of inflammation in individual on ART (usually 2-6 months after ART initiation) related to the immunological gains of ART. 

Immune reconstitution inflammatory syndrome is a reported rebound phenomenon after withdrawal of natalizumab [252, 253 ]. 

Nervous system Progressive multifocal leucoencephalopathy (PML) with immune reconstitution inflammatory syndrome (IRIS) may be a severe complication of natalizumab. Although natalizumab is often an effective treatment for patients with multiple sclerosis (MS), the mAb carries an associated risk of PML. A retrospective review of the first 40 natali-zumab-treated patients with MS revealed that 10 were also diagnosed with IRIS [174 ]. 

Metz 1, Radue E-W, Oterino A, Kumpfel T, Wiendl H, Schlppling S, et al. Pathology of immune reconstitution inflammatory syndrome in multiple sclerosis with natalizumab-associated progressive multifocal leukoencephalopathy. Acta Neuropathol 2012 123(2) 235-45. 

In a study of compassionate use of intravenous cidofovir in AIDS patients with CMV retinitis, iritis developed in 21 of 51 individuals (7). The appearance of this inflammatory process did not fit the characteristics of the vitritis associated with immune reconstitution, or with HIV-induced vitritis. The high rate in this cohort (compared with a 5-7% incidence in randomized trials) was associated with severe CMV retinitis, and the authors suggested that breakdown of the blood-ocular barrier in these patients may promote higher intraocular concentrations of cidofovir and thus enhance local toxicity. Previous correlations of prior use of HIV protease inhibitors with iritis were not confirmed in this study, although patients with iritis had better immunological and virological status than those without the disease. 

To increase immunogenicity, the hepatitis A vaccines commercially available are coupled to adjuvant aluminium phosphate or aluminium hydroxide. However, alum precipitates provoke inflammatory responses at the injection site. Immunostimulating reconstituted influenza virosomes have therefore been used as an alternative adjuvant. In 1994, a hepatitis A vaccine using the new adjuvant was licensed in Switzerland, and it was later approved for use in other countries the vaccine was well tolerated and highly immunogenic (SEDA-20,290) (SEDA-22,344). Nine people with a history of ocular sensitivity were immunized with hepatitis B, without untoward reactions. However, this result in such a small series should not be overestimated (75). There have been reports of three cases of inflammatory nodular reactions after hepatitis B immunization aluminium allergy was confirmed (76-78). 

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