| Autor: |
Safdar A; Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine and Palmetto-Richland Memorial Hospital, Columbia, South Carolina 29203, USA. safdar@richmed.medpark.sc.edu, Rubocki RJ, Horvath JA, Narayan KK, Waldron RL |
| Jazyk: |
angličtina |
| Zdroj: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2002 Nov 15; Vol. 35 (10), pp. 1250-7. Date of Electronic Publication: 2002 Oct 28. |
| DOI: |
10.1086/344056 |
| Abstrakt: |
Immune reconstitution resulting from use of highly active antiretroviral therapy in patients infected with human immunodeficiency virus type 1 (HIV-1) has been associated with a significant decrease in infectious morbidity and with improved survival. Occasionally, patients with quiescent disease due to human cytomegalovirus or nontuberculous mycobacteria may experience paradoxical worsening due to "dysregulated" restitution of the immune system (that is, immune restoration disease [IRD]). Acquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy (PML) is uncommon and often improves with immune recovery. We describe 2 HIV-1-infected patients with PML that presented with paradoxical worsening after the patients had commenced active antiretroviral therapy. After they had a transient response to high-dose corticosteroid therapy, both patients died of progressive neurological deterioration. IRD in these patients with PML was unexpected and occurred soon after they had started receiving active antiretroviral therapy, during the period of improved antigen-specific T-helper cell function. Predictors of patients' proclivity for these adverse events are uncertain. Evaluation of targeted immunomodulatory therapy directed towards disease-specific IRD is critical and may play an important role in improved survival for patients who are at risk. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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