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Updated: May 6, 2026

Simultaneous Isolation of Principal Central Nervous System-Resident Cell Types from Adult Autoimmune Encephalomyelitis Mice
Published on: October 6, 2023
Central nervous system immune reconstitution inflammatory syndrome
Nathan Bahr1, David R Boulware, Suzaan Marais
1Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, MTRF 3-222, 2001 6th Street SE, Minneapolis, MN, 55455, USA, Bahrx026@umn.edu.
Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS) affects HIV patients starting antiretroviral therapy, causing significant mortality. Understanding CNS-IRIS pathogenesis and diagnosis is crucial for effective management.
Area of Science:
- Neuroimmunology
- Infectious Diseases
- HIV Medicine
Background:
- Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS) is a serious complication in HIV patients with opportunistic CNS infections starting antiretroviral therapy (ART).
- CNS-IRIS incidence ranges from 9%-47% and mortality from 13%-75%, varying by causative pathogen.
- Commonly associated pathogens include Cryptococcus, tuberculosis (TB), and JC virus, with other microbes also implicated.
Purpose of the Study:
- To review recent advances in understanding the pathogenesis, diagnosis, and management of CNS-IRIS.
- To highlight diagnostic challenges and variable treatment responses, particularly for corticosteroids.
Main Methods:
- Literature review focusing on studies published within the last two years.
- Analysis of pathogenic mechanisms and clinical presentations of CNS-IRIS.
Main Results:
- IRIS symptoms can mimic primary infections, complicating diagnosis and necessitating consideration of treatment failure or new infections.
- Pathogenic mechanisms differ; Cryptococcal IRIS shows low baseline inflammation, while TB meningitis IRIS is linked to higher baseline inflammatory markers.
- Corticosteroids show variable efficacy, with the strongest evidence for TB-IRIS treatment.
Conclusions:
- Advances in understanding CNS-IRIS pathogenesis are emerging.
- Improved diagnostic strategies are needed to address symptom overlap and delayed treatment.
- Further research is required to optimize management and improve outcomes for CNS-IRIS patients.
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