Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions

Lewis J Haddow, Robert Colebunders, Graeme Meintjes, Stephen D Lawn, Julian H Elliott, Yukari C Manabe, Paul R Bohjanen, Somnuek Sungkanuparph, Philippa J Easterbrook, Martyn A French, David R Boulware, International Network for the Study of HIV-associated IRIS (INSHI), Lewis J Haddow, Robert Colebunders, Graeme Meintjes, Stephen D Lawn, Julian H Elliott, Yukari C Manabe, Paul R Bohjanen, Somnuek Sungkanuparph, Philippa J Easterbrook, Martyn A French, David R Boulware, International Network for the Study of HIV-associated IRIS (INSHI)

Abstract

Cryptococcal immune reconstitution inflammatory syndrome (IRIS) may present as a clinical worsening or new presentation of cryptococcal disease after initiation of antiretroviral therapy (ART), and is thought to be caused by recovery of cryptococcus-specific immune responses. We have reviewed reports of cryptococcal IRIS and have developed a consensus case definition specifically for paradoxical crytopcoccal IRIS in patients with HIV-1 and known cryptococcal disease before ART, and a separate definition for incident cryptococcosis developed during ART (termed ART-associated cryptococcosis), for which a proportion of cases are likely to be unmasking cryptococcal IRIS. These structured case definitions are intended to aid design of future clinical, epidemiological, and immunopathological studies of cryptococcal IRIS, to standardise diagnostic criteria, and to facilitate comparisons between studies. As for definitions of tuberculosis-associated IRIS, definitions for cryptococcal IRIS should be regarded as preliminary until further insights into the immunopathology of IRIS permit their refinement.

Conflict of interest statement

Conflict of interest

None

Copyright © 2010 Elsevier Ltd. All rights reserved.

References

    1. WHO. Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector. Progress report. 2007. Apr [cited 3 Oct. 2008]. Available from: .
    1. Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA. Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa. Clin Infect Dis. 2003;36:652–662.
    1. Chariyalertsak S, Sirisanthana T, Saengwonloey O, Nelson KE. Clinical presentation and risk behaviours of patients with acquired immunodeficiency syndrome in Thailand, 1994–1998: regional variation and temporal trends. Clin Infect Dis. 2001;32:955–962.
    1. Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23(4):525–530.
    1. Singh N, Perfect JR. Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis. 2007 Jun;7(6):395–401.
    1. Singh N, Lortholary O, Alexander BD, Gupta KL, John GT, Pursell K, et al. An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients. Clin Infect Dis. 2005 Jun 15;40(12):1756–1761.
    1. Singh N, Perfect JR. Immune reconstitution syndrome and exacerbation of infections after pregnancy. Clin Infect Dis. 2007 Nov 1;45(9):1192–1199.
    1. Meintjes G, Lawn SD, Scano F, Maartens G, French MA, Worodria W, et al. Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings. Lancet Infect Dis. 2008;8:516–523.
    1. Kambugu A, Meya DB, Rhein J, O'Brien M, Janoff EN, Ronald AR, et al. Outcomes of cryptococcal meningitis in Uganda before and after the availability of highly active antiretroviral therapy. Clin Infect Dis. 2008;46(10):1694–1701.
    1. Shelburne SA, Darcourt J, White WA, Greenberg SB, Hamill RJ, Atmar RL, et al. The role of immune reconstitution inflammatory syndrome in AIDS-related Cryptococcus neoformans disease in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;40(7):1049–1052.
    1. Shelburne SA, Visnegarwala F, Darcourt J, Graviss EA, Giordano TP, White AC, Jr, et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS. 2005;19(4):399–406.
    1. Lortholary O, Fontanet A, Memain N, Martin A, Sitbon K, Dromer F. Incidence and risk factors of immune reconstitution inflammatory syndrome complicating HIV-associated cryptococcosis in France. AIDS. 2005;19(10):1043–1049.
    1. Parkes-Ratanshi R, Kamali A, Wakeham K, Levin J, Nabiryo Lwanga C, Kenya-Mugisha N, et al. Successful primary prevention of cryptococcal disease using fluconazole prophylaxis in HIV-infected Ugandan adults. 16th Conference on Retroviruses and Opportunistic Infections; Montreal, Canada. 2009.
    1. Lawn SD, Bekker LG, Myer L, Orrell C, Wood R. Cryptococcocal immune reconstitution disease: a major cause of early mortality in a South African antiretroviral programme. AIDS. 2005;19(17):2050–2052.
    1. Murdoch DM, Venter WDF, Feldmann C, Van Rie A. Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study. AIDS. 2008;22:601–610.
    1. Michelet C, Arvieux C, Francois C, Besnier JM, Rogez JP, Breux JP, et al. Opportunistic infections occurring during highly active antiretroviral treatment. AIDS. 1998;12:1815–1822.
    1. Meya DB, Manabe YC, Castelnuovo B, Cook BA, Elbireer AM, Kambugu A, et al. Serum cryptococcal antigen (CRAG) screening is a cost-effective method to prevent death in HIV-infected persons with CD4 <100/mcL starting HIV therapy in resource-limited settings. Clin Infect Dis. 2010 In Press.
    1. Bicanic T, Harrison T, Niepieklo A, Dyakopu N, Meintjes G. Symptomatic relapse of HIV-associated cryptococcal meningitis after initial fluconazole monotherapy: the role of fluconazole resistance and immune reconstitution. Clin Infect Dis. 2006;43(8):1069–1073.
    1. Sungkanuparph S, Jongwutiwes U, Kiertiburanakul S. Timing of cryptococcal immune reconstitution inflammatory syndrome after antiretroviral therapy in patients with AIDS and cryptococcal meningitis. J Acquir Immune Defic Syndr. 2007;45(5):595–595.
    1. Antinori S, Ridolfo AL, Fasan M, Magni C, Galimberti L, Milazzo L, et al. AIDS-associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy. HIV Med. 2008;10(1):6–11.
    1. Bicanic T, Meintjes G, Rebe K, Williams A, Loyse A, Wood R, et al. Immune reconstitution inflammatory syndrome in HIV-associated cryptococcal meningitis: a prospective study. Journal of Acquired Immune Deficiency Syndromes. 2009;51(2):130–134.
    1. Boulware DR, Bonham SC, Meya DB, Wiesner DL, Park GS, Kambugu A, et al. Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome. J Infect Dis. 2010 In Press.
    1. Sungkanuparph S, Filler SG, Chetchotisakd P, Pappas PG, Nolen TL, Manosuthi W, et al. Cryptococcal immune reconstitution inflammatory syndrome after antiretroviral therapy in AIDS patients with cryptococcal meningitis: a prospective multicenter study. Clin Infect Dis. 2009;49(6):931–934.
    1. da Cunha Colombo ER, Mora DJ, Silva-Vergara ML. Immune reconstitution inflammatory syndrome (IRIS) associated with Cryptococcus neoformans infection in AIDS patients. Mycoses. 2010 in press.
    1. Robertson J, Meier M, Wall J, Ying J, Fichtenbaum CJ. Immune reconstitution syndrome in HIV: validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis. 2006;42(11):1639–1646.
    1. Manabe YC, Campbell JD, Sydnor E, Moore RD. Immune reconstitution inflammatory syndrome. Risk factors and treatment implications. J Acquir Immune Defic Syndr. 2007;46:456–462.
    1. Haddow LJ, Easterbrook PJ, Mosam A, Khanyile NG, Parboosing R, Moodley P, et al. Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis. 2009;49:1424–1432.
    1. Blanche P, Gombert B, Ginsburg C, Passeron A, Stubei I, Rigolet A. HIV combination therapy: immune restitution causing cryptococcal lymphadenitis dramatically improved by anti-inflammatory therapy. Scand J Infect Dis. 1998;30:615–616.
    1. Legendre U, Battegay M, Nuttli I, Dalquen P, Nuesch R. Simultaneous occurrence of 2 HIV-related immune reconstitution diseases after initiation of highly active antiretroviral therapy. Scand J Infect Dis. 2001;33:388–389.
    1. McCombe JA, Auer RN, Maingat FG, Houston S, Gill MJ, Power C. Neurologic immune reconstitution inflammatory syndrome in HIV/AIDS: outcome and epidemiology. Neurology. 2009;72(9):835–841.
    1. Woods ML, MacGinley R, Eisen D, Allworth AM. HIV combination therapy: partial immune reconstitution unmasking latent cryptococcal infection. AIDS. 1998;12:1491–1494.
    1. Lanzafame M, Trevenzoli M, Carretta G, Lazzarini L, Vento S, Concia E. Mediastinal lymphadenitis due to cryptococcal infection in HIV-positive patients on highly active antiretroviral therapy. Chest. 1999;116:848–849.
    1. Manfredi R, Pieri SA, Stefano AP, Chiodo F. The changing face of AIDS-related opportunism: Cryptococcosis in the highly active antiretroviral therapy (HAART) era. Case reports and literature review. Mycopathologia. 1999;148:73–78.
    1. Cinti SK, Armstrong WS, Kauffman CA. Case report. Recurrence of increased intracranial pressure with antiretroviral therapy in an AIDS patient with cryptococcal meningitis. Mycoses. 2001;44:497–501.
    1. Breton G, Seilhean D, Cherin P, Herson S, Benveniste O. Paradoxical intracranial cryptococcoma in a human immunodeficiency virus-infected man being treated with combination antiretroviral therapy. Am J Med. 2002;113:155–157.
    1. Jenny-Avital ER, Abadi M. Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy. Clinical Infectious Diseases. 2002;35(12):e128–e133.
    1. King MD, Perlino CA, Cinnamon J, Jernigan JA. Paradoxical recurrent meningitis following therapy of cryptococcal meningitis: an immune reconstitution syndrome after initiation of highly active antiretroviral therapy. Int J STD AIDS. 2002;13(10):724–726.
    1. Rambeloarisoa J, Batisse D, Thiebaut JB, Mikol J, Mrejen S, Karmochkine M, et al. Intramedullary abscess resulting from disseminated cryptococcosis despite immune restoration in a patient with AIDS. J Infect. 2002;44(3):185–188.
    1. Trevenzoli M, Cattelan AM, Rea F, Sasset L, Semisa M, Lanzafame M. Mediastinitus due to cryptococcal infection: a new clinical entity in the HAART era. J Infect. 2002;45:173–179.
    1. Boelaert JR, Goddeeris KH, Vanopdenbosch LJ, Casselman JW. Relapsing meningitis caused by persistent cryptococcal antigens and immune reconstitution after the initiation of highly active antiretroviral therapy. AIDS. 2004;18:1223–1224.
    1. Cattelan AM, Trevenzoli M, Sasset L, Lanzafame M, Marchioro U, Meneghetti F. Multiple cerebral cryptococcomas associated with immune reconstitution in HIV-1 infection. AIDS. 2004;18(2):349–351.
    1. Skiest DJ, Hester LJ, Hardy RD. Cryptococcal immune reconstitution inflammatory syndrome: report of four cases in three patients and review of the literature. J Infect. 2005;51(5):289–297.
    1. York J, Bodi I, Reeves I, Riordan-Eva P, Easterbrook PJ. Raised intracranial pressure complicating cryptococcal meningitis: immune reconstitution inflammatory syndrome or recurrent cryptococcal disease? J Infect. 2005;51(2):165–171.
    1. Broom J, Woods ML, Allworth AM. Immune reconstitution inflammatory syndrome producing atypical presentations of cryptococcal meningitis: case report and a review of immune reconstitution-associated cryptococcal infections. Scand J Infect Dis. 2006;38(3):219–221.
    1. Khanna N, Nuesch R, Buitrago-Tellez C, Battegay M, Hirsch HH. Hearing loss after discontinuing secondary prophylaxis for cryptococcal meningitis: relapse or immune reconstitution? Infection. 2006;34(3):163–168.
    1. Haddow LJ, Sahid F, Moosa MY. Cryptococcal breast abscess in an HIV-positive patient: arguments for reviewing the definition of immune reconstitution inflammatory syndrome. J Infect. 2007;57(1):82–84.
    1. Huits RM, Bremmer R, Enting RH, Sprenger HG, van Assen S. Return of meningeal symptoms in a patient treated for cryptococcal meningitis. Journal of Neurology. 2007;254(10):1443–1444.
    1. Tahir M, Sharma SK, Sinha S, Das CJ. Immune reconstitution inflammatory syndrome in a patient with cryptococcal lymphadenitis as the first presentation of acquired immunodeficiency syndrome. Journal of Postgraduate Medicine. 2007;53(4):250–252.
    1. Gąsiorowski J, Knysz B, Szetela B, Gładysz A. Cutaneous cryptococcosis as a rare manifestation of the immune reconstitution syndrome in an HIV-1-infected patient. Postepy Hig Med Dosw (Online) 2008;62:1–3.
    1. Khurana RN, Javaheri M, Rao N. Ophthalmic manifestations of immune reconstitution inflammatory syndrome associated with Cryptococcus neoformans. Ocular immunology and inflammation. 2008;16(4):185–190.
    1. Putignani L, Antonucci G, Paglia MG, Vincenzi L, Festa A, De Mori P, et al. Cryptococcal lymphadenitis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-positive patient: a case report and review of the literature. International Journal of Immunopathology and Pharmacology. 2008;21(3):751–756.
    1. Shelburne SA, 3rd, Hamill RJ, Rodriguez-Barradas MC, Greenberg SB, Atmar RL, Musher DW, et al. Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore) 2002 May;81(3):213–227.
    1. Jongwutiwes U, Malathum K, Sungkanuparph S. Cryptococcal meningoradiculitis: an atypical presentation after initiation of antiretroviral therapy. J Med Assoc Thai. 2007;90 Suppl 2:85–88.
    1. Lehloenya R, Meintjes G. Dermatologic manifestations of the immune reconstitution inflammatory syndrome. Dermatol Clin. 2006;24:549–570.
    1. Boulware DR, Meya DB, Bergemann TL, Wiesner D, Bonham S, Kambugu A, et al. Serum inflammatory biomarkers predict HIV immune reconstitution inflammatory syndrome and death after cryptococcal meningitis. Abstract 774. 16th Conference on Retroviruses and Opportunistic Infections (CROI); Montreal, Canada. 2009.
    1. Garcia-Hermoso D, Janbon G, Dromer F. Epidemiological evidence for dormant Cryptococcus neoformans infection. J Clin Micro. 1999;37(10):3204–3209.
    1. Jarvis JN, Lawn SD, Vogt M, Bangani N, Wood R, Harrison TS. Screening for cryptococcal antigenemia in patients accessing an antiretroviral treatment program in South Africa. Clinical Infectious Diseases. 2009;48:856–862.
    1. Pongsai P, Atamasirikul K, Sungkanuparph S. The role of serum cryptococcal antigen screening for the early diagnosis of cryptococcosis in HIV-infected patients with different ranges of CD4 cell counts. J Infect. 2010 Jun;60(6):474–477.
    1. Graybill JR, Sobel J, Saag M, van Der Horst C, Powderly W, Cloud G, et al. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. The NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups. Clin Infect Dis. 2000 Jan;30(1):47–54.
    1. French MA. Immune reconstitution inflammatory syndrome: a reappraisal. Clin Infect Dis. 2009;48(1):101–107.
    1. Lawn SD, Wilkinson RJ, Lipman MC, Wood R. Immune reconstitution and "unmasking" of tuberculosis during antiretroviral therapy. Am J Respir Crit Care Med. 2008;177:680–685.
    1. French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS. 2004 Aug 20;18(12):1615–1627.
    1. Lawn SD, Wainwright H, Orrell C. Fatal unmasking tuberculosis immune reconstitution disease with bronchiolitis obliterans organizing pneumonia: the role of macrophages. AIDS. 2009;23(1):143–145.
    1. Manabe YC, Breen RAM, Perti T, Girardi E, Sterling TR. Unmasking tuberculosis and tuberculosis immune reconstitution inflammatory disease: a disease spectrum after initiation of antiretroviral therapy. J Infect Dis. 2009;199:437–444.
    1. Goldsack NR, Allen S, Lipman MC. Adult respiratory distress syndrome as a severe immune reconstitution disease following the commencement of highly active antiretroviral therapy. Sex Transm Infect. 2003;79(4):337–338.
    1. Powderly WG. Cryptococcal meningitis and AIDS. Clin Infect Dis. 1993;17:837–842.
    1. Boulware DR, Meya DB, Bonham S, Janoff EN, Kambugu A, Bohjanen PR. Clinical manifestations and cytokine profiles in HIV-infected Ugandans who develop immune reconstitution inflammatory syndrome (IRIS). Infectious Diseases Society of America 46th Annual Meeting; Washington D.C.. 2008.
    1. Boulware DR, Meya DB, Bonham S, Janoff EN, Kambugu A, Bohjanen PR. Clinical manifestations and cytokine profiles in HIV-infected Ugandans who develop immune reconstitution inflammatory syndrome (IRIS). Infectious Diseases Society of America 46th Annual Meeting; Washington D.C.. 2008.
    1. Meintjes G, Wilkinson KA, Rangaka MX, Skolimowska K, van Veen K, Abrahams M, et al. Th1 and FoxP3 positive T cells and the HIV-tuberculosis immune reconstitution inflammatory syndrome. Am J Respir Crit Care Med. 2008
    1. Seddiki N, Sasson SC, Santner-Nanan B, Munier M, van Bockel D, Ip S, et al. Proliferation of weakly suppressive regulatory CD4+ T cells is associated with over-active CD4+ T-cell responses in HIV-positive patients with mycobacterial immune restoration disease. Eur J Immunol. 2009;39:391–403.
    1. Ruhwald M, Ravn P. Immune reconstitution syndrome in tuberculosis and HIV-co-infected patients: Th1 explosion or cytokine storm? AIDS. 2007;21(7):882–883.
    1. Singh N, Perfect JR. Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis. 2007;7:395–401.
    1. Bourgarit A, Carcelain G, Martinez V, Lascoux C, Delcey V, Gicquel B, et al. Explosion of tuberculin-specific Th1-responses induces immune restoration syndrome in tuberculosis and HIV co-infected patients. AIDS. 2006;20(2):F1–F7.
    1. Lawn SD, Bekker L-G, Miller RF. Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis. 2005;5(6):361–373.
    1. Lawn SD, Myer L, Bekker LG, Wood R. Tuberculosis-associated immune reconstitution disease: incidence, risk factors and impact in an antiretroviral treatment service in South Africa. AIDS. 2007;21:335–341.
    1. Manosuthi W, Van Tieu H, Mankatitham W, Lueangniyomkul A, Ananworanich J, Avihingsanon A, et al. Clinical case definition and manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2009 Nov 27;23(18):2467–2471.
    1. Haddow LJ, Moosa MY, Easterbrook PJ. Validation of a published case definition for tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2010;24:103–108.
    1. Ratnam I, Chiu C, Kandala NB, Easterbrook PJ. Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort. Clin Infect Dis. 2006;42(3):418–427.
    1. Kumarasamy N, Chaguturu S, Mayer KH, Solomon S, Yepthomi HT, Balakrishnan P, et al. Incidence of immune reconstitution syndrome in HIV/tuberculosis-coinfected patients after initiation of generic antiretroviral therapy in India. J Acquir Immune Defic Syndr. 2004;37(5):1574–1576.
    1. Breton G, Duval X, Estellat C, Poaletti X, Bonnet D, Mvondo Mvondo D, et al. Determinants of immune reconstitution inflammatory syndrome in HIV type 1-infected patients with tuberculosis after initiation of antiretroviral therapy. Clin Infect Dis. 2004;39(11):1709–1712.
    1. Lawn SD, Badri M, Wood R. Tuberculosis among HIV-infected patients receiving HAART: long term incidence and risk factors in a South African cohort. AIDS. 2005;19:2109–2116.
    1. French MA, Mallal SA, Dawkins RL. Zidovudine-induced restoration of cell-mediated immunity to mycobacteria in immunodeficient HIV-infected patients. AIDS. 1992;6(11):1293–1297.
    1. Kamya MR, Mayanja B, Kambugu A, Bakeera-Kitaka S, Semitala F, Mwebaze-Songa P, et al. Predictors of long-term viral failure among Ugandan children and adults treated with antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;46(2):187–193.
    1. Phillips P, Bonner S, Gataric N, Bai T, Wilcox P, Hogg R, et al. Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long-term follow-up. Clin Infect Dis. 2005;41:1483–1497.
    1. Liu PY, Yang Y, Shi ZY. Cryptococcal liver abscess: a case report of successful treatment with amphotericin-B and literature review. Jpn J Infect Dis. 2009;62(1):59–60.
    1. Jurado R, Carpenter SL, Rimland D. Case reports: trimethoprim-sulfamethoxazole-induced meningitis in patients with HIV infection. Am J Med Sci. 1996;312(1):27–29.
    1. Longley N, Muzoora C, Taseera K, Mwesigye J, Rwebembera J, Chakera A, et al. Dose Response Effect of High-Dose Fluconazole for HIV-Associated Cryptococcal Meningitis in Southwestern Uganda. Clin Infect Dis. 2008;47(12):1556–1561.
    1. Saag MS, Powderly WG, Cloud GA, Robinson P, Grieco MH, Sharkey PK, et al. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. The NIAID Mycoses Study Group and the AIDS Clinical Trials Group. New England Journal of Medicine. 1992;326(2):83–89.
    1. van der Horst CM, Saag MS, Cloud GA, Hamill RJ, Graybill JR, Sobel JD, et al. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. New England Journal of Medicine. 1997;337(1):15–21.
    1. Brouwer AE, Rajanuwong A, Chierakul W, Griffin GE, Larsen RA, White NJ. Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial. Lancet. 2004;363:1764–1767.
    1. Pappas PG, Chetchotisakd P, Larsen RA, Manosuthi W, Morris MI, Anekthananon T, et al. A phase II randomized trial of amphotericin B alone or combined with fluconazole in the treatment of HIV-associated cryptococcal meningitis. Clin Infect Dis. 2009;48:1775–1783.
    1. Hamill RJ. Free fluconazole for cryptococcal meningitis: too little of a good thing? Clin Infect Dis. 2006;43:1074–1076.
    1. Antinori S. Cryptococcosis: we should do better! Clin Infect Dis. 2006;43:948–949.
    1. McCarthy KM, Morgan J, Wannemuehler KA, Mirza SA, Gould SM, Mhlongo N, et al. Population-based surveillance for cryptococcosis in an antiretroviral-naive South African province with a high HIV seroprevalence. AIDS. 2006;20(17):2199–2206.
    1. Moosa MY, Coovadia YM. Cryptococcal meningitis in Durban, South Africa: a comparison of clinical features, laboratory findings, and outcome for human immunodeficiency virus (HIV)-positive and HIV-negative patients. Clin Infect Dis. 1997;24(2):131–134.
    1. Menichetti F, Fiorio M, Tosti A, Gatti G, Pasticci MB, Miletich F, et al. High-dose fluconazole therapy for cryptococcal meningitis in patients with AIDS. Clin Infect Dis. 1996;22:838–840.
    1. Haubrich RH, Haghighat D, Bozzette SA, Tilles J, McCutchan JA. High dose fluconazole for treatment of cryptococcal disease in patients with human immunodeficiency virus infection. The California Collaborative Treatment Group. J Infect Dis. 1994;170:238–242.
    1. Meintjes G, Rangaka MX, Maartens G, Rebe K, Morroni C, Pepper DJ, et al. Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance. Clin Infect Dis. 2009;48(5):667–676.
    1. Liechty CA, Solberg P, Were W, Ekwaru JP, Ransom RL, Weidle PJ, et al. Asymptomatic serum cryptococcal antigenaemia and early mortality during antiretroviral therapy in rural Uganda. Tropical Medicine and International Health. 2007;12(8):929–935.
    1. French N, Gray K, Watera C, Nakiyingi J, Lugada E, Moore M, et al. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. AIDS. 2002;16(7):1031–1038.
    1. Micol R, Lortholary O, Sar B, Laureillard D, Ngeth C, Dousset JP, et al. Prevalence, determinants of positivity, and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune Defic Syndr. 2007;45(5):555–559.
    1. Zolopa A, Andersen J, Powderly W, Sanchez A, Sanne I, Suckow C, et al. Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One. 2009;4(5):e5575.
    1. Makadzange AT, Ndhlovu CE, Takarinda K, Reid M, Kurangwa M, Gona P, et al. Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in Sub-Saharan Africa. Clin Infect Dis. 2010 Apr 23;50(11):1532–1538.
    1. Kaplan J, Benson C, Holmes K, Brooks J, Pau A, Masur H. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR. 2009;58:1–207.
    1. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2010 Jan 4;50 In Press.
    1. Meintjes G, Wilkinson RJ, Morroni C, Pepper DJ, Rebe K, Rangaka MX, et al. Randomized placebo-controlled trial of prednisone for TB IRIS; Conference on Retroviruses and Opportunistic Infections; 2009. Abstract 34.
    1. Saag MS, Graybill RJ, Larsen RA, Pappas PG, Perfect JR, Powderly WG, et al. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis. 2000;30:710–718.
    1. Bonham S, Meya DB, Bohjanen PR, Boulware DR. Biomarkers of HIV immune reconstitution inflammatory syndrome. Biomarker Medicine. 2008;2(4):349–361.
    1. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis and Rheumatism. 1988;31(3):315–324.
    1. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis and Rheumatism. 1982;25(11):1271–1277.
    1. HIV Lipodystrophy Case Definition Study Group. An objective case definition of lipodystrophy in HIV-infected adults: a case-control study. Lancet. 2003;361:726–735.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren