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Prednisone for the Prevention of Paradoxical Tuberculosis-Associated IRIS
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Kidney Diseases Associated with Human Immunodeficiency Virus Infection
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CD32a is a marker of a CD4 T-cell HIV reservoir harbouring replication-competent proviruses
Life expectancy in HIV-positive persons in Switzerland: matched comparison with general population
Successful Prevention of Transmission of Integrase Resistance in the Swiss HIV Cohort Study
Immunologic Biomarkers, Morbidity, and Mortality in Treated HIV Infection
Rosuvastatin slows progression of subclinical atherosclerosis in patients with treated HIV infection
Antiretroviral therapy for the prevention of HIV-1 transmission
HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy
Review of the Efficacy, Safety, and Pharmacokinetics of Raltegravir in Pregnancy
Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals
Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013
Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis
Outcomes of HIV-associated Hodgkin lymphoma in the era of antiretroviral therapy
CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection
Ongoing HIV Replication Replenishes Viral Reservoirs During Therapy
Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men
Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy
Course and Clinical Significance of CD8+ T-Cell Counts in a Large Cohort of HIV-Infected Individuals
Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients
Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1
Increased Metabolic Activity on 18F-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography in Human Immunodeficiency Virus–Associated Immune Reconstitution Inflammatory Syndrome
Published by François RAFFI
Updated: 24 July, 2019
Background. Immune reconstitution inflammatory syndrome (IRIS) represents an unexpected inflammatory response shortly after initiation of ART in some HIV–infected patients with underlying neoplasia or OIs, including tuberculosis. We hypothesized that IRIS is associated with increased glycolysis and that 18F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET/CT) could help identify high-risk subjects.
Methods. In this prospective cohort study, 30 HIV-infected patients (CD4+ count <100 cells/μL) underwent FDG-PET/CT scans at baseline and 4–8 weeks after ART initiation.
Ten patients developed IRIS (6 mycobacterial).
Results. At baseline, total glycolytic activity, total lesion volume, and maximum standardized uptake values (SUVs) of pathologic FDG uptake (reflective of opportunistic disease burden) were significantly higher in IRIS vs non-IRIS (P = .010, .017, and .029, respectively) and significantly correlated with soluble inflammatory biomarkers (interferon-γ, myeloperoxidase, tumor necrosis factor, interleukin 6, soluble CD14).
Baseline bone marrow and spleen FDG uptake was higher in mycobacterial IRIS specifically. After ART initiation, BM and spleen mean SUV decreased in non-IRIS (p = .004, .013) but not IRIS subjects. Our results were supported by significantly higher glucose transporter 1 (Glut-1) expression of CD4+ cells and monocytes after ART initiation in IRIS/mycobacterial IRIS compared with non-IRIS patients.
Conclusions. We conclude that increased pathologic metabolic activity on FDG-PET/CT prior to ART initiation is associated with IRIS development and correlates with inflammatory biomarkers. Abnormally elevated BM and spleen metabolism is associated with mycobacterial IRIS, HIV viremia, and Glut-1 expression on CD4+ cells and monocytes.