Integrase strand transfer inhibitor treatment does not increase the incidence of immune reconstitution inflammatory syndrome in HIV‐infected Koreans

Abstract We report a case of chronic hepatosplenic aspergillosis following immune reconstitution complicating colic aspergillosis in an AIDS patient with multicentric Castleman disease. Symptoms mimicked the clinical presentation of chronic disseminated candidiasis and responded to corticosteroid. This emerging entity enlarges the spectrum of fungal immune reconstitution inflammatory syndrome in the HIV setting.

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Inflammatory Myositis Secondary to Anti-Retroviral Therapy in a Child; Case Report and Review of the Literature

Journal of Neuromuscular Diseases ◽

10.3233/jnd-210669 ◽

2021 ◽

pp. 1-7

Author(s):

Marie Monaghan ◽

Charlotte Loh ◽

Stephen Jones ◽

Agyepong Oware ◽

Kathryn Urankar ◽

...

Keyword(s):

Drug Regimen ◽

Dramatic Improvement ◽

Strand Transfer ◽

Inflammatory Myositis ◽

Once Daily ◽

Immune Mediated ◽

Show Evidence ◽

Transfer Inhibitor ◽

Integrase Strand Transfer Inhibitor

Here, we describe a five year old girl with congenital HIV who had a six-week onset of rapidly deteriorating mobility and progressive proximal muscle weakness, associated with a raised Creatine Kinase (CK) level of 4330 U/L [25–200 U/L], subsequently diagnosed with an inflammatory myositis. Potential causes were investigated by paediatric neurology and immunology teams. Her viral load had been undetectable over the preceding two years, excluding a primary HIV myositis. While MRI scanning did not show evidence of definite myositis, a muscle biopsy showed evidence of an inflammatory process, comprising a moderate endomysial, perimysial and perivascular mononuclear (CD8 + T cell) infiltrate with increased MHC expression. No particular features of dermatomyositis or immune-mediated necrotising myopathy were identified and there were no features of an inclusion body myositis. Given the absence of active HIV infection, the role of anti-retroviral medications was considered. She had had a recent switch in medication, from twice daily Raltegravir (an Integrase Strand Transfer Inhibitor, INSTI) to once daily Dolutegravir (an INSTI) while continuing on an established daily protocol of Abacavir and Lamivudine (Nucleoside Reverse Transcriptase Inhibitors). Changing the Dolutegravir back to Raltegravir, in combination with continuing Lamivudine and Abacavir for two months made no difference to her weakness or CK levels. Moreover, this drug regimen had been well-tolerated over the preceding 19 month period. Changing the anti-retroviral regime completely to a single drug class (Protease Inhibitors) of Ritonavir and Darunavir, resulted in a dramatic improvement in her symptomatology. Within ten days she regained the ability to stand and walk, with a reduction in her CK from 1700 U/L at time of switch to 403 U/L [25–200]. This case highlights the potential risk of developing inflammatory myositis from anti-retrovirals even 19 months into treatment.

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Prevalence of integrase strand transfer inhibitor (INSTIs) resistance mutations in Henan Province, China (2018–2020)

Infection ◽

10.1007/s15010-021-01668-9 ◽

2021 ◽

Author(s):

Zhaojie Yang ◽

Xuan Yang ◽

Xin Deng ◽

Shuguang Wei ◽

Jinjin Liu ◽

...

Keyword(s):

Henan Province ◽

Strand Transfer ◽

Resistance Mutations ◽

Transfer Inhibitor ◽

Integrase Strand Transfer Inhibitor

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High Levels of TNF-α and TIM-3 as a Biomarker of Immune Reconstitution Inflammatory Syndrome in People with HIV Infection

Life ◽

10.3390/life11060527 ◽

2021 ◽

Vol 11 (6) ◽

pp. 527

Author(s):

Lucero A. Ramon-Luing ◽

Ranferi Ocaña-Guzman ◽

Norma A. Téllez-Navarrete ◽

Mario Preciado-García ◽

Dámaris P. Romero-Rodríguez ◽

...

Keyword(s):

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Control Group ◽

Hiv Patients ◽

Art Initiation ◽

Tnf Α ◽

Ifn Γ ◽

Α Level ◽

Inflammatory Syndrome

Immune reconstitution inflammatory syndrome (IRIS) is an exacerbated immune response that can occur to HIV+ patients after initiating antiretroviral therapy (ART). IRIS pathogenesis is unclear, but dysfunctional and exhausted cells have been reported in IRIS patients, and the TIM-3/Gal-9 axis has been associated with chronic phases of viral infection. This study aimed to evaluate the soluble levels of TIM-3 and Gal-9 and their relationship with IRIS development. TIM-3, Gal-9, TNF-α, IFN-γ, IL-6, TNFR1, TNFR2, E-cadherin, ADAM10, and ADAM17 were measured to search for IRIS-associated biomarkers in plasma samples from 0-, 4-, 8-, 12-, and 24-weeks after ART initiation of 61 HIV+ patients (15 patients developed IRIS, and 46 did not). We found that patients who developed IRIS had higher levels of TIM-3 [median 4806, IQR: 3206–6182] at the time of the IRIS events, compared to any other follow-up time evaluated in these patients or compared with a control group of patients who did not develop IRIS. Similarly, IRIS patients had a higher TNF-α level [median 10.89, IQR: 8.36–12.34] at IRIS events than any other follow-up time evaluated. Other molecules related to the TIM-3 and TNF-α pathway (Gal-9, IL-6, IFN-γ, TNFR1, TNFR2, ADAM-10, and ADAM-17) did not change during the IRIS events. In conclusion, our data suggest that a high level of soluble TIM-3 and TNF-α could be used as an IRIS biomarker.

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Disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a female patient with HIV infection

BMJ Case Reports ◽

10.1136/bcr-2020-241037 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241037

Author(s):

Jacqueline Alexandra Bachofner ◽

Kristian Ikenberg ◽

Bettina Schulthess ◽

Johannes Nemeth

Keyword(s):

Hiv Infection ◽

Mycobacterium Avium ◽

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Avium Infection ◽

Inflammatory Syndrome ◽

Mycobacterium Simiae ◽

Mycobacterium Avium Infection ◽

Standard Treatment Regimen

This case study discusses the management of a disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a 52-year-old woman with HIV infection. Disseminated M. avium infections have extensively been described in HIV patients; however, reports of infections with M. simiae are rare. Treatment of M. simiae infections is challenging due to its high rates of natural drug resistances, and thus far, no standard treatment regimen exists.

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