INTRODUCTION The diagnosis of IRIS is based on evidence of clinical worsening and immune reconstitution in the setting of combined antiretroviral therapy (cART) initiation. While central nervous system IRIS (CNS IRIS) is thought to be prevalent in resource limited settings (RLS), its identification is constrained by limited data on pre-treatment HIV disease and diagnostic testing. A diagnosis can be improved with neuroimaging and cerebrospinal fluid (CSF) studies, which are not universally available in RLS. This study evaluated whether diagnoses of CNS IRIS could be achieved in a resource limited setting based on established criteria. METHODS A retrospective chart review of HIV+ individuals, on ARVs at the time of presentation in two cohort studies of suspected CNS opportunistic infection or tuberculous (TB) meningitis who were admitted to a tertiary care facility in Lusaka, Zambia. RESULTS Using currently validated criteria, none of the 254 participants evaluated could be diagnosed with CNS IRIS, as there was no information on post-treatment trajectory of HIV viral loads or CD4 counts. Only one participant had a definitive, non-IRIS infectious diagnosis based on comprehensive testing. Of the remaining 253 patients, 68 (27%) had an identified potential CNS pathogen, 92 (36%) had inflammatory CSF in the absence of a pathogen, and 94 (37%) had normal CSF despite presenting with CNS symptoms. CONCLUSION The absence of HIV disease trajectory data, and lack of comprehensive diagnostic testing, compounded by a high prevalence of infectious pathogens, substantially limits the ability to diagnose CNS IRIS in RLS.

中文翻译：

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中枢神经系统免疫重建炎症综合征：资源有限环境中诊断的局限性


引言 IRIS 的诊断基于联合抗逆转录病毒治疗 (cART) 背景下临床恶化和免疫重建的证据。虽然中枢神经系统 IRIS (CNS IRIS) 被认为在资源有限的环境 (RLS) 中普遍存在，但其识别受到治疗前 HIV 疾病和诊断测试数据有限的限制。通过神经影像学和脑脊液 (CSF) 研究可以改善诊断，而这些研究在 RLS 中并不普遍可用。本研究评估了是否可以根据既定标准在资源有限的环境中实现 CNS IRIS 的诊断。方法 对入住赞比亚卢萨卡三级医疗机构的疑似中枢神经系统机会性感染或结核性（TB）脑膜炎的两项队列研究中的 HIV+ 个体进行回顾性图表审查，并在提交时使用抗逆转录病毒药物。结果 使用当前经过验证的标准，所评估的 254 名参与者中没有一人能够被诊断为 CNS IRIS，因为没有有关 HIV 病毒载量或 CD4 计数的治疗后轨迹的信息。根据综合检测，只有一名参与者获得了明确的非 IRIS 感染诊断。在其余 253 名患者中，68 名 (27%) 患者存在已确定的潜在 CNS 病原体，92 名 (36%) 患者在不存在病原体的情况下存在炎性脑脊液，94 名 (37%) 患者尽管出现中枢神经系统症状，但脑脊液正常。结论 由于缺乏 HIV 疾病轨迹数据，缺乏全面的诊断检测，加上传染性病原体的高流行，极大地限制了 RLS 中 CNS IRIS 的诊断能力。