Two cases of immune reconstitution inflammatory syndrome in HIV patients treated with thalidomide

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is a clinical manifestation that accompanies paradoxical deterioration of symptoms in human immunodeficiency virus (HIV)-infected patients after commencement of antiretroviral treatment. This disease is caused by immune dysregulation, resulting in a cytokine storm and limited effector T-cell function. IRIS treatment involves supportive care and corticosteroid therapy to regulate the immune response. However, prolonged steroid therapy may increase the risk of opportunistic infections. Previous studies have highlighted the use of thalidomide to shorten the duration of steroid use. Herein, we report two cases of IRIS in HIV-infected patients whose symptoms were successfully controlled with thalidomide therapy. Both patients had opportunistic infections involving the central nervous system; one patient had cryptococcal meningitis and the other had progressive multifocal leukoencephalopathy.