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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cryptococcosis-IRIS is associated with lower cryptococcus-specific IFN-γ responses before antiretroviral therapy but not higher T-cell responses during therapy
Journal of Infectious Diseases, Volume 208, No. 6, Year 2013
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Description
Background. Cryptococcosis-associated immune reconstitution inflammatory syndrome (C-IRIS) may be driven by aberrant T-cell responses against cryptococci. We investigated this in human immunodeficiency virus (HIV)-infected patients with treated cryptococcal meningitis (CM) commencing combination antiretroviral therapy (cART).Methods. Mitogen-and cryptococcal mannoprotein (CMP)-activated (CD25+CD134+) CD4+ T cells and-induced production of interferon-gamma (IFN-γ), IL-10, and CXCL10 were assessed in whole blood cultures in a prospective study of 106 HIV-CM coinfected patients.Results. Patients with paradoxical C-IRIS (n = 27), compared with patients with no neurological deterioration (no ND; n = 63), had lower CMP-induced IFN-γ production in 24-hour cultures pre-cART and 4 weeks post-cART (P =. 0437 and. 0257, respectively) and lower CMP-activated CD4+ T-cell counts pre-cART (P =. 0178). Patients surviving to 24 weeks had higher proportions of mitogen-activated CD4+ T cells and higher CMP-induced CXCL10 and IL-10 production in 24-hour cultures pre-cART than patients not surviving (P =. 0053,. 0436 and. 0319, respectively). C-IRIS was not associated with higher CMP-specific T-cell responses before or during cART.Conclusion. Greater preservation of T-cell function and higher CMP-induced IL-10 and CXCL10 production before cART are associated with improved survival while on cART. Lower CMP-induced IFN-γ production pre-cART, but not higher CMP-specific T-cell responses after cART, were risk factors for C-IRIS. © 2013 The Author.
Authors & Co-Authors
Chang, Christina C.
Australia, Clayton
Monash University
South Africa, Durban
University of Kwazulu-natal
Australia, Melbourne
Burnet Institute
Lim, Andrew
Australia, Perth
The University of Western Australia
Omarjee, Saleha
South Africa, Durban
University of Kwazulu-natal
South Africa, Durban
The Nelson R. Mandela Medical School
Levitz, Stuart M.
United States, Worcester
University of Massachusetts Chan Medical School
Gosnell, Bernadett Isabel
South Africa, Congella
King Edward Viii Hospital
Spelman, Tim D.
Australia, Melbourne
Burnet Institute
Elliott, Julian H.
Australia, Clayton
Monash University
Carr, William Henry
South Africa, Durban
University of Kwazulu-natal
Moosa, Mohamed Yunus Suleman
South Africa, Congella
King Edward Viii Hospital
Ndung'u, Thumbi P.
South Africa, Durban
University of Kwazulu-natal
South Africa, Durban
The Nelson R. Mandela Medical School
Lewin, Sharon R.
Australia, Clayton
Monash University
Australia, Melbourne
Burnet Institute
French, Martyn A.H.
Australia, Perth
The University of Western Australia
Australia, Perth
Royal Perth Hospital
Statistics
Citations: 47
Authors: 12
Affiliations: 8
Identifiers
Doi:
10.1093/infdis/jit271
ISSN:
00221899
Research Areas
Infectious Diseases
Study Design
Cohort Study