• Lancet Infect Dis · Nov 2010

    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, and International Network for the Study of HIV-associated IRIS (INSHI).
    • Division of Immunology, Infection and Inflammatory Disease, King's College London, London, UK.
    • Lancet Infect Dis. 2010 Nov 1;10(11):791-802.

    AbstractCryptococcal 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.Copyright © 2010 Elsevier Ltd. All rights reserved.

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