Database : MEDLINE
Search on : Immune and Reconstitution and Inflammatory and Syndrome [Words]
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[PMID]: 29514237
[Au] Autor:Frigati L; Archary M; Rabie H; Penazzato M; Ford N
[Ad] Address:Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town.
[Ti] Title:Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease.
[So] Source:Clin Infect Dis;66(suppl_2):S147-S151, 2018 Mar 04.
[Is] ISSN:1537-6591
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Early mortality and morbidity remain high in children initiating antiretroviral therapy (ART), especially in sub-Saharan Africa. Many children still present with advanced human immunodeficiency virus (HIV) disease. Tuberculosis, pneumonia, and severe bacterial infections are the main causes of hospital admission in HIV-infected children. In contrast to adults with advanced HIV disease, cryptococcal disease is not common in childhood, although there is a peak in infancy and adolescence. Interventions such as TB screening in symptomatic children, and isoniazid and cotrimoxazole prophylaxis should be implemented. There is evidence suggesting that rapid initiation (within 1 week) of ART in children with severe malnutrition or those with advanced HIV disease admitted to hospital is not beneficial and should be delayed until their condition has been stabilized. Research informing the prevention of severe bacterial infections, the management of pediatric immune reconstitution inflammatory syndrome, and other potential strategies to decrease morbidity and mortality in HIV-infected children are urgently needed.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Data-Review
[do] DOI:10.1093/cid/ciy013

  2 / 1640 MEDLINE  
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[PMID]: 29365083
[Au] Autor:Hosseinipour MC; Kang M; Krown SE; Bukuru A; Umbleja T; Martin J; Orem J; Godfrey C; Hoagland B; Mwelase N; Langat D; Nyirenda M; MacRae J; Borok-Williams M; Samaneka W; Moses A; Mngqbisa R; Busakhala N; Martínez-Maza O; Ambinder R; Dittmer DP; Nokta M; Campbell TB; A5264/AMC-067 REACT-KS team
[Ad] Address:UNC Project, Lilongwe, Malawi.
[Ti] Title:As-Needed versus Immediate Etoposide Chemotherapy in Combination with Antiretroviral Therapy for Mild or Moderate AIDS-associated Kaposi Sarcoma in Resource-Limited Settings: A5264/AMC-067 Randomized Clinical Trial.
[So] Source:Clin Infect Dis;, 2018 Jan 22.
[Is] ISSN:1537-6591
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Background: Mild-to-moderate AIDS-associated Kaposi sarcoma (KS) often responds to antiretroviral therapy (ART) alone; the role of chemotherapy is unclear. We assessed the impact of immediate versus as-needed oral etoposide (ET) among HIV-infected individuals with mild-to-moderate KS initiating ART. Methods: Chemotherapy-naïve, HIV-1-infected adults with mild-to-moderate KS initiating ART in Africa and South America were randomized to ART (TDF/FTC/EFV) alone (chemotherapy "As-Needed" arm) vs ART plus up to 8 cycles of oral ET (Immediate arm). Participants with KS progression on ART alone received ET as part of the As-Needed strategy. Primary outcome was ordinal: failure (composite of KS progression, initiation of non-study chemotherapy, lost-to-follow-up, death), stable, and response at 48 weeks. Secondary outcomes included times to initial KS progression, KS-associated immune reconstitution inflammatory syndrome (KS-IRIS), and KS response. Results: Of 190 randomized participants (As-Needed=94, Immediate=96), the majority were men (71%) and African (93%); the median age was 34 years. Failure (53.8% vs 56.6%), Stable (16.3% vs 10.8%) and Response (30% vs 32.5%) did not differ between arms (As-Needed vs Immediate) among those with Week 48 data potential (N=163, p=0.91). Times to KS progression (p=0.021), KS-IRIS (p=0.003), and KS response (p=0.003) favored the Immediate arm. 25 participants died (13%). Mortality, adverse events, CD4+ T-cell changes and HIV RNA suppression were similar at 48 weeks. Conclusion: Among HIV-infected adults initiating ART for mild-to-moderate KS, immediate ET provided early, non-durable clinical benefits. By 48 weeks, no clinical benefit was observed compared to use of ET as needed. Mortality was high and tumor response was low. ClinicalTrials.gov: NCT01352117 (https://clinicaltrials.gov/ct2/show/NCT01352117?term=NCT01352117&rank=1).
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[Cl] Clinical Trial:ClinicalTrial
[St] Status:Publisher
[do] DOI:10.1093/cid/ciy044

  3 / 1640 MEDLINE  
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[PMID]: 29194105
[Au] Autor:Manta A; Ugradar S; Murta F; Ezra D; Cormack I
[Ad] Address:Department of Oculoplastics, Moorfields Eye Hospital, London, United Kingdom.
[Ti] Title:Immune Reconstitution Inflammatory Syndrome in a Case of Nonspecific Orbital Inflammation.
[So] Source:Ophthal Plast Reconstr Surg;34(2):e54-e56, 2018 Mar/Apr.
[Is] ISSN:1537-2677
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The immune reconstitution inflammatory syndrome is an exaggerated abnormal immune response, typically seen in HIV-positive patients following restoration of a normal CD4 count as a result of initiation of antiretroviral therapy. It has been described in relation to either occult opportunistic infections or to a paradoxical relapse of a previously successfully treated infection with negative microbiological cultures. The authors report the case of a 60-year-old HIV-positive African male who presented with 2 episodes of orbital inflammation that occurred in conjunction with improvements of CD4 count following Highly Active Antiretroviral Therapy. This phenomenon was underpinned by biopsies obtained following each episode. Interestingly, on both occasions, he responded well to corticosteroid therapy. Although the soft tissues of the orbits are a common area affected by other inflammatory diseases, it is rare for them to be involved in immune reconstitution inflammatory syndrome. To the authors' knowledge, this is the first case report of immune reconstitution inflammatory syndrome affecting the orbits exclusively. The authors believe that it is probably an underdiagnosed condition and may be erroneously labeled as idiopathic in many cases. This case report inspires us to keep an open mind when dealing with patients on antiretroviral therapy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1097/IOP.0000000000001022

  4 / 1640 MEDLINE  
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[PMID]: 29406396
[Au] Autor:Kothapalli A; Khattak MA
[Ad] Address:Department of Medical Oncology, Fiona Stanley Hospital.
[Ti] Title:Safety and efficacy of anti-PD-1 therapy for metastatic melanoma and non-small-cell lung cancer in patients with viral hepatitis: a case series.
[So] Source:Melanoma Res;28(2):155-158, 2018 Apr.
[Is] ISSN:1473-5636
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Anti-PD-1 monoclonal antibodies have shown durable long-term survival benefit in patients with metastatic melanoma. Limited evidence exists on the safety and efficacy of PD-1 inhibitors in patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections as these patients have traditionally been excluded from clinical trials because of a theoretical risk of immune reconstitution inflammatory syndrome. We aim to determine the safety and efficacy of treatment with PD-1 inhibitors in seven patients with HBV/HCV infection and concurrent metastatic melanoma or non-small-cell lung cancer (NSCLC). We describe seven patients treated with PD-1 inhibitors nivolumab and pembrolizumab for either metastatic melanoma or metastatic NSCLC in the setting of chronic or past HBV/HCV infection. The safety and efficacy of treatment were analysed retrospectively by examining response to treatment, alanine transaminase (ALT) trends and viral load trends. One patient showed an increase in ALT of Common Terminology Criteria for Adverse Events (CTCAE) grade 2 severity that returned to the normal range following treatment of his HCV infection with ledipasvir 90 mg/sofosbuvir 400 mg. An additional four patients showed an increase in ALT of CTCAE grade 1 severity. The remaining two patients experienced no hepatic toxicity, with stable disease continuing after more than 24 cycles of nivolumab. Efficacy was similar to the data of published trials. Our results indicate that patients with metastatic melanoma and NSCLC can be treated safely with PD-1 inhibitors in the context of HBV/HCV infection. However, we recommend that those with active viral hepatitis be monitored closely in consultation with a hepatologist and treated with antiviral therapy if indicated.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:In-Data-Review
[do] DOI:10.1097/CMR.0000000000000434

  5 / 1640 MEDLINE  
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[PMID]: 29331332
[Au] Autor:Vega LE; Espinoza LR
[Ad] Address:Servicio de Reumatología, Hospital Central de la Fuerza Aérea, Lima, Peru. Electronic address: luisenvega@gmail.com.
[Ti] Title:HIV infection and its effects on the development of autoimmune disorders.
[So] Source:Pharmacol Res;129:1-9, 2018 Mar.
[Is] ISSN:1096-1186
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:More than 35 years have elapsed since the initial outbreak of the HIV/AIDS epidemic and the status of a considerable number of patients has changed from a fatal disorder to a chronic one where comorbidities including sarcoidosis and autoimmune diseases have become relevant and dominant. HIV targets the immune system leading to a state of immunodeficiency in a setting of immune activation in which CD4 T cell depletion plays a critical role. The onset, natural history and course of HIV-associated autoimmune disease has dramatically changed according to the stage of HIV infection and since the introduction of combined anti-retroviral therapy. There are some issues that need further study regarding therapy, especially when immunosuppressive drugs and biologic agents are under consideration. Currently, biologic agents and others immunosuppressive agents are recommended when patients have CD4 T cell counts above 200 cells/mm and the HIV viral activity is completely suppressed.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1801
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:In-Data-Review

  6 / 1640 MEDLINE  
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[PMID]: 29477993
[Au] Autor:Kapoor V; Latif A; Warraich FH; Majeed A
[Ad] Address:Department of Hematology and Oncology, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA.
[Ti] Title:First case of acute granulomatous interstitial nephritis with immune reconstitution inflammatory syndrome in a patient with HIV coinfected with disseminated .
[So] Source:BMJ Case Rep;2018, 2018 Feb 23.
[Is] ISSN:1757-790X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Restoration of immune response by highly active antiretroviral therapy (HAART) effectively improved the overall prognosis of HIV infection. However, 25%-31.7% of patients experience paradoxical worsening of pre-existing infections or unmasking of subclinical infections after starting HAART therapy, which is termed as immune reconstitution inflammatory syndrome (IRIS). Acute granulomatous interstitial nephritis as a consequence of IRIS has never been reported with coinfection. Here, we describe an HIV/AIDS patient coinfected with disseminated infection, who presented with acute kidney injury 4.5 months after initiation of HAART. The diagnostic workup revealed IRIS was the cause of acute kidney injury. Short-term course of prednisone (1 mg/kg/day) along with antimycobacterial and HAART regimen achieved significant improvement.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180225
[Lr] Last revision date:180225
[St] Status:In-Process

  7 / 1640 MEDLINE  
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[PMID]: 29466918
[Au] Autor:Anand P; Saylor D
[Ad] Address:Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
[Ti] Title:Multiple sclerosis and HIV: a case of multiple sclerosis-immune reconstitution inflammatory syndrome associated with antiretroviral therapy initiation.
[So] Source:Int J STD AIDS;:956462418754972, 2018 Jan 01.
[Is] ISSN:1758-1052
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Studies have suggested that the incidence of multiple sclerosis (MS) in HIV-infected (HIV+) patients is lower than that of the general population. Here, we present a case of MS in an HIV+ patient with a relatively suppressed CD4 cell count who developed clinical and radiographic disease worsening in the setting of antiretroviral therapy (ART) initiation. A 47-year-old HIV+ woman (CD4 cell count 216 cells/µl) presented with decreased vision in her right eye. Magnetic resonance imaging (MRI) revealed optic nerve enhancement and open ring-enhancing lesions in the brain concerning for demyelinating disease. Cerebrospinal fluid was tested extensively for infection and malignancy with no abnormal findings. She received five days of intravenous methylprednisolone. Nine days later, she was restarted on ART. Three weeks later, she was readmitted with left eye vision loss and left hemiplegia (CD4 cell count 342 cells/µl). Repeat imaging showed multiple new enhancing lesions. Several cases have described severe MS relapses and unusually widespread demyelinating lesions on MRI after withdrawal of immunosuppressive drugs. We posit that the clinical and radiographic progression that occurred in our patient after initiation of ART represented an immune reconstitution response to ART. Caution may be warranted when initiating ART in HIV+ patients with suppressed CD4 cell count and active MS.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180222
[Lr] Last revision date:180222
[St] Status:Publisher
[do] DOI:10.1177/0956462418754972

  8 / 1640 MEDLINE  
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[PMID]: 29173177
[Au] Autor:Psichogiou M; Basoulis D; Tsikala-Vafea M; Vlachos S; Kapelios CJ; Daikos GL
[Ad] Address:1st Internal Medicine Department, Laiko General Hospital, National and Kapodistrian University of Athens, Greece.
[Ti] Title:Integrase Strand Transfer Inhibitors and the Emergence of Immune Reconstitution Inflammatory Syndrome (IRIS).
[So] Source:Curr HIV Res;15(6):405-410, 2017.
[Is] ISSN:1873-4251
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) is a major concern when starting highly active anti-retroviral therapy (HAART) in new patients and especially late presenters. This study attempts to identify risk factors for IRIS and investigate whether certain treatment regimens increase the probability of IRIS for patients at risk. METHODS: Retrospective single-centre study of HIV patients treated with HAART. RESULTS: A total of 417 patients were included. We identified 45 cases of IRIS in 37 patients; an incidence of 13.3 cases over 1000 person-years. In univariate analysis, IRIS development was significantly associated with CDC stage, the presence of an opportunistic infection (OI) at diagnosis, CD4 cell count and viral load at diagnosis and HAART initiation and the use of integrase strand inhibitors (INSTIs). In multivariate analysis, INSTIs use (OR 2.89; 95%CI 1.26-6.64; p=0.012), CD4≤200/mm3 (OR 5.56; 95%CI 2.2-13.98; p<0.001), and the presence of an OI (OR 4.74; 95%CI 2.13-10.23; p=0.012) were independent risk factors. Among INSTI regimens, dolutegravir (OR 4.99 vs. NNRTI; 95%CI 1.11-22.55; p=0.037) and elvitegravir (OR 4.82 vs. NNRTI; 95%CI 1.43-16.19; p=0.011) seem to carry increased risk. Mortality was 18.9% (7/37) for IRIS patients compared to 9.7% (37/380) in the non-IRIS group. Mortality at any given time during follow-up was significantly higher in the IRIS group (HR 3.2; 95%CI 1.39-7.36; p=0.006). CONCLUSION: The use of INSTIs and especially DTG and EVG is associated with a higher probability for the development of IRIS in the background of late presentation and the presence of OIs. These data highlight the need for further research.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 180220
[Lr] Last revision date:180220
[St] Status:In-Data-Review
[do] DOI:10.2174/1570162X15666171122155708

  9 / 1640 MEDLINE  
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[PMID]: 29319289
[Au] Autor:Confalonieri M; DI Meo N; Damiani G; Torregiani C; Trevisan R; Kodric M; Trevisan G
[Ad] Address:Department of Pneumology, Trieste University Hospital, Trieste, Italy.
[Ti] Title:An adalimumab-induced late-onset immune reconstitution inflammatory syndrome treated with adalimumab.
[So] Source:G Ital Dermatol Venereol;153(1):129-130, 2018 02.
[Is] ISSN:1827-1820
[Cp] Country of publication:Italy
[La] Language:eng
[Pt] Publication type:LETTER
[Em] Entry month:1801
[Cu] Class update date: 180207
[Lr] Last revision date:180207
[St] Status:In-Process
[do] DOI:10.23736/S0392-0488.16.05430-4

  10 / 1640 MEDLINE  
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[PMID]: 29278532
[Au] Autor:Hill AM; Mitchell N; Hughes S; Pozniak AL
[Ad] Address:Department of Translational Medicine, University of Liverpool, Liverpool.
[Ti] Title:Risks of cardiovascular or central nervous system adverse events and immune reconstitution inflammatory syndrome, for dolutegravir versus other antiretrovirals: meta-analysis of randomized trials.
[So] Source:Curr Opin HIV AIDS;13(2):102-111, 2018 Mar.
[Is] ISSN:1746-6318
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE OF REVIEW: Results from nonrandomized cohort studies suggest higher risks of CNS adverse events for dolutegravir, versus other ARVs. There have been two case reports of myocarditis on dolutegravir. Integrase inhibitors have been associated with IRIS in two cohort studies. Meta-analysis of randomized trials can be used to cross-check potential safety signals. This systematic review of drug safety used an EMBASE and MEDLINE search combined with serious adverse event (SAE) reports on the website www.clinicaltrials.gov. Cardiovascular, CNS or IRIS-associated adverse events were analysed for dolutegravir versus other ARVs. Relative risks for the comparison between dolutegravir and other antiretrovirals were calculated for each adverse event. Meta-analyses applied Mantel-Haenszel random-effects models. RECENT FINDINGS: There was a higher risk of Grade 1-4 insomnia adverse events for DTG (6.1%) versus other ARVs (4.5%; P = 0.02). There was no significant difference between DTG and other ARVs in the risk of cardiovascular serious adverse events. In the SINGLE and SPRING-1 trials comparing DTG with efavirenz, there were 5/465 patients with reported suicidality SAEs on DTG (1.1%) versus 6/469 (1.3%) on EFV. In other studies, serious adverse events of suicidality were reported for 15/2250 patients on DTG (0.7%) versus 9/2257 patients on other ARVs (0.4%). Risks of IRIS were low, but event rates were low and the main trials excluded CDC stage C disease. SUMMARY: In this meta-analysis, there was no significant effect of dolutegravir on the risk of cardiac, IRIS or suicide-related serious adverse events. There was a higher risk of insomnia for DTG. Other completed randomized trials should be included in new evaluations of DTG safety. Continued pharmacovigilance, with regular meta-analyses, should be used to monitor safety.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180131
[Lr] Last revision date:180131
[St] Status:In-Data-Review
[do] DOI:10.1097/COH.0000000000000445


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