AIDS患者隐球菌相关免疫重建炎症综合征的治疗和管理

The therapeutics and management of cryptococcus-related immune reconstitution inflammatory syndrome in AIDS patients

获得性免疫缺陷综合征(Acquired immune deficiency syndrome,AIDS)患者由于机体细胞免疫功能的严重缺陷,可发生各种机会性感染。隐球菌病是AIDS患者常见的严重机会性感染。随着高效抗逆转录病毒治疗(High activity antiretroviral therapy,HAART)在全球范围内的广泛应用,AIDS相关隐球菌病病死率明显降低。但部分患者在启动HAART后,临床症状反复和加重,机体出现对隐球菌抗原过度免疫调节的炎症反应,称为隐球菌相关免疫重建炎症综合征(Cryptococcus-related immune reconstitution inflammatory syndrome,C-IRIS),严重影响患者生活质量和预后。本文就AIDS患者C-IRIS的临床特征、发病机制、治疗及管理策略进行综述。

Acquired immune deficiency syndrome(AIDS)can cause various opportunistic infections clinically due to severe defects in the body’s cellular immune function.Cryptococcosis is a common serious opportunistic infection in AIDS patients.With the promotion and popularization of high activity antiretroviral therapy(HAART)programs worldwide,the mortality rate of AIDS-related cryptococcosis has been significantly decreased.After initiating antiviral therapy,some patients experienced recurrence and aggravation of clinical symptoms during anti-cryptococcal treatment.The body has an inflammatory response to the excessive immune regulation of cryptococcal antigens,which is called cryptococcus-related immune reconstitution inflammatory syndrome(C-IRIS).C-IRIS seriously affects the quality of life and prognosis of patients.This article reviews the clinical features,pathogenesis and the latest treatment and management strategies of C-IRIS in AIDS patients.