Sasha Isadora Usiskin MBBCH, Presenter: Nothing to Disclose

Robert Miller MD, Abstract Co-Author: Nothing to Disclose

Rolf Jager MD, Abstract Co-Author: Nothing to Disclose

Margaret Anne Hall-Craggs MD, Abstract Co-Author: Nothing to Disclose

Simon Edwards MD, Abstract Co-Author: Nothing to Disclose

To describe the neuroradiological appearances of immune restoration inflammatory syndrome (IRIS) in HIV+ patients starting highly active anti-retroviral therapy (HAART).

Over a 4 year period, MR studies of the brain were performed in 168 of a cohort of 2000 adult HIV-infected patients presenting with neurological symptoms or signs. Of these, we identified a sub-group with IRIS, who showed development of new lesions, new enhancement or progression of previously documented lesions after commencing HAART and excluding alternative diagnoses.

Seven patients (five male) aged between 30 and 53 years (median 36) fulfilled the inclusion criteria. Neuroimaging showed 2 distinct patterns of IRIS: (1) development of new enhancement or increased enhancement of existing lesions, despite appropriate treatment of underlying infections (2) new, or progression of existing, non-enhancing white matter lesions, which improved after modifying HAART. The first pattern was seen in four patients and the second in three. IRIS was due to HIV itself in two cases, progressive multifocal leucoencephalopathy in one, Epstein-Barr virus in one and toxoplasmosis in three (one of whom had coexistent TB).

Immune restoration inflammatory syndrome, a ‘paradoxical’ inflammatory response, is being encountered more frequently as large numbers of HIV patients have access to HAART. Its manifestations are protean, often reflecting underlying covert infections, making IRIS a great chameleon but one which should be considered in the differential diagnosis of progressive enhancing or white matter lesions after institution of HAART. Awareness of this syndrome is important as modification of antiretroviral therapy may be required.

Usiskin, S, Miller, R, Jager, R, Hall-Craggs, M, Edwards, S, Neuroradiological Manifestations of Immune Restoration Inflammatory Syndrome in HIV.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4412183.html