CRYPTOCOCCOSIS AND HIV-INFECTION/AIDS

Cryptococcal infection affects the lungs and central nervous system (CNS) of people with HIV infection/AIDS; relapses are related to high mortality, and immune reconstitution inflammatory syndrome (IRIS) should be a concern. This syndrome may appear as unmasking IRIS after the beginning of highly active antiretroviral therapy (HAART), or paradoxical IRIS during the treatment of cryptococcosis from one to six months after the initiation of this treatment. The IRIS occurs due to the recovery of cryptococcus-specific immune responses, manifested by fever, headache, seizures, hemiplegia, paraplegia, dysarthria, lymphadenopathy, lung nodules and infiltrates, cerebral edema and abscess. Following the HAART, up to 45% of HIV/AIDS patients with cryptococcal meningoencephalitis may have a risk of lethal IRIS, similar to the post-infectious inflammatory response syndrome (PIIRS) in non-HIV transplant recipients with cryptococcal meningoencephalitis, after the immune conditioning reduction. Either IRIS or PIIRS can cause deaths of up to one-third of affected people. Their management includes restarting amphotericin B therapy (or increasing the fluconazole dose to 1200 mg daily) and associated higher doses of dexamethasone for severe CNS inflammation, besides reduction of intracranial hypertension.