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Immune reconstitution disease of the central nervous system

Torok, M Esteea,b; Kambugu, Andrewc; Wright, Edwinad,e,f

Current Opinion in HIV and AIDS: July 2008 - Volume 3 - Issue 4 - p 438–445
doi: 10.1097/COH.0b013e328302ebd1
Immune restoration disease: Edited by Robert Colebunders and Martyn French

Purpose of review The purpose of this review is to examine the literature concerning immune reconstitution disease associated with the central nervous system infections.

Recent findings Immune reconstitution disease is an adverse consequence of antiretroviral therapy, characterized by an aberrant immune response and presenting with new or worsening clinical symptoms and signs after initiation of antiretroviral therapy. Immune reconstitution disease may be associated with a broad spectrum of infectious pathogens, and has been described in the context of central nervous system infections, including progressive multifocal leucoencephalopathy, human herpesvirus infections, cryptococcal meningitis and tuberculous meningitis. Central nervous system immune reconstitution disease is a challenging condition as the clinical features are nonspecific, there is no agreed case definition, the immunopathogenesis is poorly understood, and the optimal treatment strategy is unknown. Central nervous system immune reconstitution disease appears to be associated with worse outcome than extracranial immune reconstitution disease.

Summary Reports of central nervous system immune reconstitution disease are increasing and this trend is likely to continue as access to antiretroviral therapy improves in resource-limited settings in which many central nervous system infections are endemic. Considerable challenges remain in the prevention, diagnosis and management of these conditions.

aOxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam

bCentre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK

cInfectious Diseases Institute, Makerere University, Kampala, Uganda

dAlfred Hospital, Melbourne, Australia

eMonash University, Victoria, Australia

fThe Burnet Institute, Melbourne, Australia

Correspondence to M. Estee Torok, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, District 5, Ho Chi Minh City, Vietnam Tel: +84 8 923 7954; fax: +84 8 923 8904; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.