IRIS Immune reconstitution syndrome in HIV

NEUROLOGY 2009;72:835-841

Patients with low CD4 counts initiating cART therapy who then bump their CD4 counts and lower viral counts are at risk. Patients may or may not have concurrent infection. Authors describe 7 patients, with Neuro IRIS.

Presentations include trouble walking, seizure, encephalopathy, and occurred in early phase-- first 2-3 weeks after initiation of therapy (early, due to memory cells) or delayed, after 4-6 weeks phase (due to proliferation of new T lymphocytes)/ Latter tended to be a more prolonged course. Biopsy of one patient showed lots of CD8 and CD40 cells stained positive. CSF showed pleocytosis, and MRI showed diffuse white matter changes with enhancement. Lamivudine was in all cases one of the therapies used. The overall risk was 0.9 % among patients starting cART, but 1.5% when stratified with those having low CD4 count to start (<200). This is much lower than the number of non neuro IRIS cases that have been considered to be as high as 15 % although these numbers may be high.