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

LJ Haddow, R Colebunders, G Meintjes, SD Lawn, JH Elliott, YC Manabe, PR Bohjanen, S Sungkanuparph, PJ Easterbrook, MA French, DR Boulware

    Research output: Contribution to journalA1: Web of Science-article

    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
    Original languageEnglish
    JournalLancet Infectious Diseases
    Volume10
    Issue number11
    Pages (from-to)791-802
    Number of pages12
    ISSN1473-3099
    DOIs
    Publication statusPublished - 2010

    Keywords

    • B780-tropical-medicine
    • Viral diseases
    • HIV-1
    • AIDS
    • Immune reconstitution inflammatory syndrome (IRIS)
    • IRIS
    • Cryptococcosis
    • Co-infections
    • Case definition
    • Classification
    • Mortality
    • Risk factors
    • Clinical manifestations
    • Symptoms
    • Diagnosis
    • Prevention
    • Management
    • Review of the literature

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