Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Infectious Disease Reports
Published in: Current Infectious Disease Reports 6/2013

01-12-2013 | Central Nervous System (J Lyons, Section Editor)

Central Nervous System Immune Reconstitution Inflammatory Syndrome

Authors: Nathan Bahr, David R. Boulware, Suzaan Marais, James Scriven, Robert J. Wilkinson, Graeme Meintjes

Published in: Current Infectious Disease Reports | Issue 6/2013

Login to get access

Abstract

Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS) develops in 9 %–47 % of persons with HIV infection and a CNS opportunistic infection who start antiretroviral therapy and is associated with a mortality rate of 13 %–75 %. These rates vary according to the causative pathogen. Common CNS-IRIS events occur in relation to Cryptococcus, tuberculosis (TB), and JC virus, but several other mycobacteria, fungi, and viruses have been associated with IRIS. IRIS symptoms often mimic the original infection, and diagnosis necessitates consideration of treatment failure, microbial resistance, and an additional neurological infection. These diagnostic challenges often delay IRIS diagnosis and treatment. Corticosteroids have been used to treat CNS-IRIS, with variable responses; the best supportive evidence exists for the treatment of TB-IRIS. Pathogenic mechanisms vary: Cryptococcal IRIS is characterized by a paucity of cerebrospinal inflammation prior to antiretroviral therapy, whereas higher levels of inflammatory markers at baseline predispose to TB meningitis IRIS. This review focuses on advances in the understanding of CNS-IRIS over the past 2 years.
Literature
1.
Mateen FJ, Nath A. Central nervous system – immune reconstitution inflammatory syndrome in resource-limited settings: current burden and future needs. AIDS. 2012;26:1851–5.PubMedCrossRef
2.
Mirza SA, Phelan M, Rimland D, et al. The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992–2000. Clin Infect Dis. 2003;36(6):789–94.PubMedCrossRef
3.
d’Arminio Monforte A, Cinque P, Mocroft A, et al. Changing incidence of central nervous system diseases in EuroSIDA cohort. Annals of Neurol. 2004;55(3):320–8.CrossRef
4.
5.
• Meintjes G, Scriven J and Marais S. Management of immune reconstitution inflammatory syndrome. Curr HIV/AIDS Rep. 2012; 9: 138–50. This is a comprehensive update of management strategies for various common forms of IRIS. CrossRef
6.
French MA. Disorders of immune reconstitution in patients with HIV infection responding to antiretroviral therapy. Curr HIV/AIDS Rep. 2007;4:16–21.PubMedCrossRef
7.
• Haddow LJ, Colebunders R, Meintjes G, et al. Cryptococcal immune reconstitution syndrome in HIV-1 infected individuals: proposed clinical case definitions. Lancet Infect Dis. 2010; 10: 791–802. This paper provides case definitions of CM-IRIS based on current literature. Variation in case definitions of CM-IRIS used across studies has handicapped a broad understanding of CM-IRIS and the ability to compare studies. PubMedCrossRef
8.
Miravalle A, Jensen R, Kinkel RP. Immune reconstitution inflammatory syndrome in patients with multiple sclerosis following cessation of Natalizumab therapy. Arch Neurol. 2011;68(2):186–91.PubMedCrossRef
9.
Narayanan S, Banerjee C, Holt PA. Cryptococcal immune reconstitution syndrome during steroid withdrawal with hydroxychloroquine. Internat J Infect Dis. 2011;15:e70–3.CrossRef
10.
Katusiime C, Ocama P, Kambugu A. A case report: Herpes zoster IRIS in pregnancy. Afric Health Sci. 2009;9(4):294–5.
11.
Meintjes G, Lawn SD, Scano F, et al. Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings. Lancet Infect Dis. 2008;8:516–23.PubMedCrossRef
12.
Riveiro-Barciela M, Falco V, Burgos J, et al. Neurological opportunistic infections and neurological immune reconstitution syndrome: impact of one decade of highly active antiretroviral treatment in a tertiary hospital. HIV Medicine. 2013;14:21–30.PubMedCrossRef
13.
Asselman V, Thienemann F, Pepper DJ, et al. Central nervous system disorders after starting antiretroviral therapy in South Africa. AIDS. 2010;24(18):2871–6.PubMedCrossRef
14.
• Boulware DR, Meya DB, Bergemann TL, et al. Clinical features and serum biomarkers in HIV immune reconstitution inflammatory syndrome after Cryptococcus meningitis: a prospective cohort study. PLoS Med. 2010; 7: e1000384. This prospective study of 101 patients provides possible serum biomarkers for predicting CM-IRIS, in addition to adding to understanding of CM-IRIS pathogenesis. PubMedCrossRef
15.
• Tan K, Roda R, Ostrow L, et al. PML-IRIS in patients with HIV infection: Clinical manifestations and treatment with steroids. Neurology. 2009; 72: 1458–64. This retrospective study provides the best understanding of HIV-related PML-IRIS risk factors that is currently available. PubMedCrossRef
16.
•• Marais S, Meintjes G, Pepper DJ, et al. Frequency, severity, and prediction of tuberculosis meningitis immune reconstitution inflammatory syndrome. Clin Infect Dis. 2013; 56(3): 450–60. This prospective study provides insights regarding the pathogenesis of neuro-TB-IRIS through biomarkers characterization and identifies clinical risk factors for the development of neuro-TB-IRIS. PubMedCrossRef
17.
Pepper DJ, Marais S, Maartens G, et al. Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clin Infect Dis. 2009;48(11):e96–e107.PubMedCrossRef
18.
• Agarwal U, Kumar A, Behera D, et al. Tuberculosis associated immune reconstitution inflammatory syndrome in patients infected with HIV: meningitis a potentially life threatening manifestation. AIDS Res Ther. 2012; 9(1) 17. A small descriptive study highlighting the significant mortality associated with neurological TB-IRIS. PubMedCrossRef
19.
Bicanic T, Meintjes G, Rebe K, et al. Immune Reconstitution Inflammatory Syndrome in HIV-associated Cryptococcal meningitis: a prospective study. J Acquir Immune Defic Sydnr. 2009;51:130–4.CrossRef
20.
da Cunha Colombo ER, Mora DJ, Silva-Vergara ML. Immune reconstitution inflammatory syndrome (IRIS) associated with Cryptococcus neoformans infection in AIDS patients. Mycoses. 2010;54:e178–82.PubMedCrossRef
21.
Sungkanuparph S, Giller SG, Chetchotisakd P, et al. Cryptococcal immune reconstitution syndrome after antiretroviral therapy in AIDS patients with cryptococcal meningitis: a prospective multicenter study. Clin Infect Dis. 2009;49:931–4.PubMedCrossRef
22.
Boulware DR, Bonham SC, Meya DB, et al. Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome. J Infect Dis. 2010;202(6):962–70.PubMedCrossRef
23.
•• Chang CC, Dorasamy AA, Gosnell BI, et al. Clinical and mycological predictors of cryptococcosis-associated immune reconstitution inflammatory syndrome. AIDS. 2013; 27: 000–000. This carefully performed prospective study describes risk factors for CM-IRIS. A particularly important finding is that CSF culture positivity prior to ART initiation predicts IRIS. CrossRef
24.
Haddow LJ, Easterbrook PJ, Mosam A, et al. Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis. 2009;49:1424–32.PubMedCrossRef
25.
Park BJ, Wannemuehler KA, Marston BJ, et al. Estimation of the current burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23:525–30.PubMedCrossRef
26.
Muller M, Wandel S, Colebunders R, et al. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:251–61.PubMedCrossRef
27.
Rhein J, Boulware DB. Prognosis and management of cryptococcal meningitis in patients with human immunodeficiency virus infection. Neurobehavioral HIV Medicine. 2012;4:45–61.
28.
Jarvis, J. CSF cytokine profiles in patients with HIV-associated cryptococcal meningitis: correlates with clinical outcome. Presented at the 8th International Conference on Cryptococcus and Cryptococcosis; Charleston, SC. May 4, 2011
29.
30.
Sungkanuparph S, Jongwutiwes U, Kiertiburanakul S. Timing of cryptococcal immune reconstitution inflammatory syndrome after antiretroviral therapy in patients with AIDS and cryptococcal meningitis. J Acquir Immune Defic Syndr. 2007;45(5):595–6.PubMedCrossRef
31.
Lortholary O, Fontanet A, Memain N, et al. Incidence and risk factors of immune reconstitution inflammatory syndrome complicating HIV-associated cryptococcosis in France. AIDS. 2005;19:1043–9.PubMedCrossRef
32.
Scourfield A, Waters L, Tittle V, et al. Azathioprine use as a novel treatment for cryptococcal immune reconstitution and inflammatory syndrome in HIV. 17th Annual Conference of the British HIV Association, Bournemouth, 2011, abstract P92.
33.
Brunel AS, Reynes J, Tuaillon E, et al. Thalidomide for steroid-dependent immune reconstitution inflammatory syndromes during AIDS. AIDS. 2012;26(16):2110–1.PubMedCrossRef
34.
Sitapati AM, Kao CL, Cachay ER, et al. Treatment of HIV-related inflammatory cerebral cryptococcoma with adalimumab. Clin Infect Dis. 2010;50:e7–e10.PubMedCrossRef
35.
Musubire AK, Meya DB, Mayanja-Kizza H, et al. Challenges in diagnosis and management of cryptococcal immune reconstitution inflammatory syndrome (IRIS) in resource limited settings. African Health Sciences. 2012;12(2):226–30.PubMedCrossRef
36.
37.
Makadznage AT, Ndhlovu CE, Takarinda K, et al. Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in sub-Saharan Africa. Clin Infect Dis. 2010;50:1532–8.CrossRef
38.
Zolopa A, Anderson J, Powderly W, et al. Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One. 2009;4(5):e5575.PubMedCrossRef
39.
Boulware DB, Meya DB, Muzoora C, et al. ART initiation within the first 2 weeks of cryptococcal meningitis is associated with higher mortality: a multisite randomized trial. 20th Conference on Retroviruses and Opportunistic Infections, Atlanta, 2013, abstract #144.
40.
Bisson GP, Nthobatsong R, Thakur R, et al. The use of HAART is associated with decreased risk of death during initial treatment of cryptococcal meningitis in adults in Botswana. J Acquir Immune Defic Syndr. 2008;49(2):227–9.PubMedCrossRef
41.
Meya DB, Manabe YC, Castelnuovo B, et al. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count < or = 100 cells/microL who start HIV therapy in resource-limited settings. Clin Infect Dis. 2010;51:448–55.PubMedCrossRef
42.
Murdoch DM, Venter WD, Feldman C, Van Rie A. Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study. AIDS. 2008;22:601–10.PubMedCrossRef
43.
French N, Gray K, Watera C, Nakiyingi J, et al. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. AIDS. 2002;16:1031–8.PubMedCrossRef
44.
Jarvis JN, Lawn SD, Vogt M, et al. Screening for cryptococcal antigenemia in patients accessing an antiretroviral treatment program in South Africa. Clin Infect Dis. 2009;48:856–62.PubMedCrossRef
45.
Liechty CA, Solberg P, Were W, et al. Asymptomatic serum cryptococcal antigenaemia and early mortality during antiretroviral therapy in rural Uganda. Trop Med Int Health. 2007;12:929–35.PubMedCrossRef
46.
Micol R, Lortholary O, Sar B, et al. Prevalence, determinants of positivity, and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune Defic Syndr. 2007;45:555–9.PubMedCrossRef
47.
Govender NP, Chetty V, Roy M, et al. Phased implementation of screening for cryptococcal disease in South Africa. S Afr Med J. 2012;102:914–7.PubMedCrossRef
48.
Narendran G, Andrade BB, Porter BO, et al. Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) in HIV patients with culture confirmed pulmonary tuberculosis in India and the potential role of IL-6 in prediction. PLoSONE. 2013;8(5):e63541.CrossRef
49.
Vidal JE, Cimerman S, Schiavon Nogueira R, et al. Paradoxical reaction during treatment of tuberculous brain abscess in a patient with AIDS. Rev Inst Med Trop Sao Paulo. 2003;45(3):177–8.PubMedCrossRef
50.
Tadokera R, Meintjes G, Skolimowska KH, et al. Hypercytokinaemia accompanies HIV-tuberculosis immune reconstitution inflammatory syndrome. Eur Respir J. 2011;37(5):1248–59.PubMedCrossRef
51.
Meintjes G, Skolimowska KH, Wilkinson KA, et al. Corticosteroid-modulated immune activation in the tuberculosis immune reconstitution inflammatory syndrome. Am J Respir Crit Care Med. 2012;186(4):369–77.PubMedCrossRef
52.
Marais S, Scholtz P, Pepper DJ, et al. Neuroradiological features of the tuberculosis-associated immune reconstitution inflammatory syndrome. Int J Tuberc Lung Dis. 2010;14(2):188–96.PubMed
53.
Meintjes G, Wilkinson RJ, Morroni C, et al. Randomized placebo-controlled trial of prednisone for paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS. 2010;24(15):2381–90.PubMed
54.
Thwaites GE, Nguyen DB, Nguyen HD, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004;351(17):141–51.CrossRef
55.
Havlir DV, Kendall MA, Ive P, et al. Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011;365(16):1482–91.PubMedCrossRef
56.
Blanc FX, Sok T, Laureillard. Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis. N Engl J Med. 2011;365(16):1471–81.PubMedCrossRef
57.
Abdool Karim SS, Naidoo K, Grobler A, et al. Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med. 2011;365(16):1492–501.PubMedCrossRef
58.
Torok ME, Farrar JJ. When to start antiretroviral therapy in HIV-associated tuberculosis. N Engl J Med. 2011;365(16):1538–40.PubMedCrossRef
59.
•• Torok ME, Yen NT, Chau TT, et al. Timing of initiation of antiretroviral therapy in human immunodeficiency virus (HIV)--associated tuberculous meningitis. Clin Infect Dis. 2011; 52(11): 1374–83. This is the only randomized controlled trial to specifically focus on timing of ART initiation in patients with tuberculous meningitis. Although this trial did not assess the occurrence of IRIS, findings suggest that early ART has no mortality benefit in severely immunosuppressed patients with tuberculous meningitis. PubMedCrossRef
60.
61.
Major EO. Progressive multifocal leukoencephalopathy in patients on immunomodulatory therapies. Annu Rev Med. 2010;61:35–47.PubMedCrossRef
62.
Cinque P, Pierotti C, Vigano MG, et al. The good and evil of HAART in HIV-related progressive multifocal leukoencephalopathy. J Neurovirol. 2001;7:358–63.PubMedCrossRef
63.
• Gheuens S, Ngo L, Wang X, et al. Metabolic profile of PML lesions in patients with and without IRIS. Neurol. 2012; 79: 1041–8. This study included both HIV-positive and -negative patients. It had a prospective design and characterized the metabolic markers of PML-IRIS. CrossRef
64.
Ferenczy MW, Marshall LJ, Nelson CD, et al. Molecular biology, epidemiology, and pathogenesis of Progressive Multifocal Leukoencephalopathy, the JC Virus-induced demyelinating disease of the human brain. Clin Microbiol Rev. 2012;25(3):4871–506.CrossRef
65.
Harrison DM, Newsome SD, Skolasky RL, et al. Immune reconstitution is not a prognostic factor in progressive multifocal leukoencephaopathy. J Neuroimmuno. 2011;238:81–6.CrossRef
66.
Berger JR, Aksamit AJ, Clifford DB, et al. PML diagnostic criteria: consensus statement from the AAN neuroinfectious disease section. Neurology. 2013;80(15):1430–8.PubMedCrossRef
67.
Marzocchetti A, Di Giambenedetto S, Cingolani A, et al. Reduced rate of diagnostic positive detection of JC virus DNA in cerebrospinal fluid in cases of suspected progressive multifocal leukoencephalopathy in the era of potent antiretroviral therapy. J Clin Microbiol. 2005;43(8):4175–7.PubMedCrossRef
68.
Lima MA, Koralnik IJ. New features of progressive multifocal leukoencephalopathy in the era of highly active antiretroviral therapy and natalizumab. J Neurovirol. 2005;11(Supp 3):52–7.PubMedCrossRef
69.
Bachis A, Avdoshina V, Zecca L, et al. Human immunodeficiency virus type 1 alters brain-derived neurotrophic factor processing in neurons. J Neuroscience. 2012;32(28):9477–84.CrossRef
70.
Tozzi V, Balestra P, Lorenzini P, et al. Prevalence and risk factors for human immunodeficiency virus – associated neurocognitive impairment, 1996 to 2002: results from an urban observational cohort. J Neurovirol. 2005;11:265–73.PubMedCrossRef
71.
Lescure FX, Omland LH, Engsig FN, et al. Incidence and impact on mortality of severe neurocognitive disorders in persons with and without HIV infection: a Danish nationwide cohort study. Clin Infect Dis. 2011;52(2):235–43.PubMedCrossRef
72.
Everall I, Vaida F, Khanlou N, et al. Cliniconeuropathologic correlates of human immunodeficiency virus in the era of antiretroviral therapy. J Neurovirol. 2009;15:360–70.PubMedCrossRef
73.
74.
Miller RF, Isaacson PG, Hall-Craggs M, et al. Cerebral CD8+ lymphocytosis in HIV-1 infected patients with immune restoration induced by HAART. Acta Neuropathol. 2004;108:17–23.PubMedCrossRef
75.
Oelschlage C, Dziewas R, Reichelt D, et al. Severe leukoencephalopathy with fulminant cerebral edema reflecting immune reconstitution inflammatory syndrome during HIV infection: a case report. J Med Case Reports. 2010;4:214.CrossRef
76.
Venkataramana A, Pardo CA, McArthur JC, et al. Immune reconstitution inflammatory syndrome in the CNS of HIV-infected patients. Neurol. 2006;67:383–8.CrossRef
77.
Pacifici M, Delbue S, Ferrante P, et al. Cerebrospinal fluid miRNA profile in HIV-encephalitis. J Cellul Physiol. 2013;228:1070–5.PubMedCrossRef
78.
Gelman BB, Chen T, Lisinicchia JG, et al. The national neuroAIDS tissue consortium brain gene array: two types of HIV-associated neurocognitive impairment. PLoS One. 2012;7(9):e46178.PubMedCrossRef
79.
Johnson T, Nath A. Immune reconstitution inflammatory syndrome and the central nervous system. Curr Opin Neurol. 2011;24:284–90.PubMedCrossRef
80.
81.
Lescure FX, Moulignier A, Savatovsky J, et al. CD8 encephalitis in HIV-infected patients receiving cART: a treatable entity. Clin Infect Dis. 2013;57:101–8.PubMedCrossRef
82.
Mayor AM, Fernandez Santos DM, Dworkin MS, et al. Toxoplasmic encephalitis in an AIDS cohort at Puerto Rico before and after highly active antiretroviral therapy. Am J Trop Med Hyg. 2011;84(5):838–41.PubMedCrossRef
83.
Tremont-Lukat IW, Garciarena P, Juarbe R, El-Abassi RN. The immune inflammatory reconstitution syndrome and central nervous system toxoplasmosis. Ann Intern Med. 2009;150(9):656–7.CrossRef
84.
Tsambiras PE, Larkin JA, Houston SH. Case report. Toxoplasma encephalitis after initiation of HAART. AIDS Read. 2001;11(12):608–10. 615–6.PubMed
85.
•• Barber DL, Andrade BB, Sereti I, Sher A. Immune reconstitution inflammatory syndrome: the trouble with immunity when you had none. Nature Reviews Microbiol. 2012; 10: 150–6. This paper makes a significant conceptual contribution to the IRIS field by proposing a mechanism by which HIV-related and non-HIV-related IRIS might share similar pathogenic features.
86.
Gheuens S, Smith DR, Wang X, et al. Simultaneous PML-IRIS after discontinuation of natalizumab in a patient with MS. Neurology. 2012;78:1390–3.PubMedCrossRef
87.
Schwab N, Hohn KG, Schneider-Hohendorf T, et al. Immunological and clinical consequences of treating a patient with natalizumab. Multiple Sclerosis Journal. 2012;18(3):335–44.PubMedCrossRef
88.
Aly L, Yousef S, Schippling S, et al. Central role of JC virus-specific CD4+ lymphocytes in a progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome. Brain. 2011;134:2687–702.PubMedCrossRef
89.
Ermis U, Weis J, Schulz JB. PML in a patient treated with Fumaric Acid. New Engl J Med. 2013;368(17):1657–8.PubMedCrossRef
90.
Schwab N, Ulzheimer JC, Fox RJ, et al. Fatal PMJ associated with efalizumab therapy: Insights into integrin αLβ2 in JC virus control. Neurology. 2012;78:4258–67.CrossRef
91.
Blackmore TK, Manning L, Taylor WJ, Wallis RS. Therapeutic use of infliximab in tuberculosis to control severe paradoxical reaction of the brain and lymph nodes. Clin Infect Dis. 2008;47:e83–5.PubMedCrossRef
92.
Jorge JH, Graciela C, Pablo AP, Luis SH. A life-threatening central nervous system-tuberculosis inflammatory reaction nonresponsive to corticosteroids and successfully controlled by infliximab in a young patient with a variant of juvenile idiopathic arthritis. J Clin Rheumatol. 2012;18:189–91.PubMed
93.
Singh N, Lortholary O, Alexander BD, et al. An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients. Clin Infect Dis. 2005;40:1756–61.PubMedCrossRef
94.
Legris T, Massad M, Purgus R, et al. Immune reconstitution inflammatory syndrome mimicking relapsing cryptococcal meningitis in a renal transplant recipient. Transpl Infect Dis. 2011;13:303–8.PubMedCrossRef
95.
Airas L, Paivarinta M, Roytta M, et al. Central nervous system immune reconstitution inflammatory syndrome (IRIS) after hematopoietic SCT. Bone Marrow Transplantation. 2010;45:593–6.PubMedCrossRef
Metadata
Title
Central Nervous System Immune Reconstitution Inflammatory Syndrome
Authors
Nathan Bahr
David R. Boulware
Suzaan Marais
James Scriven
Robert J. Wilkinson
Graeme Meintjes
Publication date
01-12-2013
Publisher
Springer US
Published in
Current Infectious Disease Reports / Issue 6/2013
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-013-0378-5

Other articles of this Issue 6/2013

Current Infectious Disease Reports 6/2013 Go to the issue

Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)

Organ Transplantation in HIV Patients: Current Status and New Directions

Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)

West Nile Virus Infection in the Immunocompromised Patient

Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)

Multidrug-Resistant Bacteria in Organ Transplantation: An Emerging Threat with Limited Therapeutic Options

CENTRAL NERVOUS SYSTEM (J LYONS, SECTION EDITOR)

Central Nervous System Infections in Travelers

Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)

Influenza Vaccination in Oncology Patients

Invited Commentary

Current Issues in Transplant Infectious Diseases
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits