Immune reconstitution inflammatory syndrome associated with cryptococcal meningitis: risk factors and biomarkers
DOI:
https://doi.org/10.17696/2318-3691.28.1.2021.2129Keywords:
Immune Reconstitution Inflammatory Syndrome; Acquired Immunodeficiency Syndrome; HIV; Antiretroviral Therapy, Highly Active; Meningitis, Cryptococcal; Biomarkers; Cerebrospinal FluidAbstract
Introduction: Immune Reconstitution Inflammatory Syndrome (IRIS) presents itself as an exaggerated immune response during an unregulated immune restoration in immunocompromised patients in an advanced stage of HIV infection when starting treatment with antiretrovirals. Any opportunistic pathogen can cause this type of disorder during immune restoration. Objective: Identify recent advances in risk factors and molecular biomarkers of prognosis and diagnosis of Immune Reconstitution Inflammatory Syndrome associated with cryptocococcal meningitis to understand its immunopathogenesis better. Methods: Scope review as proposed by Joana Briggs Institute. Two independent researchers searched the PubMed and Google Scholar databases, using descriptors and their synonyms. Results: The search resulted in 240 articles. Of these, we excluded 36 duplicated articles; 1 used animal models; 3 were about seronegative patients for HIV; 8 were not about Cryptococcus; 3 were about tuberculosis and one about pulmonary cryptococcosis. We focused on studies that analyzed risk factors and biomarkers in blood/plasma and cerebrospinal fluid, which may clarify the immunopathogenesis of the Inflammatory Immune Reconstitution Syndrome associated with cryptococcosis. Conclusion: We present a review of studies on risk factors in biomarkers of the discoveries in blood and cerebrospinal fluid that can assist in the diagnosis of Immune Reconstitution Inflammatory Syndrome in cryptococcal meningitis. These risk factors and the use of these biomarkers can be used to identify patients at risk who would be subjected to more rigorous clinical monitoring and adjustment of treatment protocols in AIDS patients co-infected with Cryptococcus.
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