Table 3 Investigations during IRIS, therapy, and outcome
Author | HIV viral load during IRIS (copies/ml) | CD + Count during IRIS (cells/mm3) | Syphilis serology during IRIS | Spinal tap and CSF analysis (yes or no, normal or alteration type, syphilis test) | Skin biopsy (yes or no), immunostaining (positive or negative, and syphilis PCR on | Other invasive exams | Imaging | Syphilis therapy | IRIS therapy (yes or no and type) | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|
(treponemal/non treponemal) | samples | (yes or no and type) | ||||||||
Mitra et al. [3] | 0 | 160 | Positive/Negative | Yes, normal, serology negative, PCR not performed | Yes, immunostaining and PCR not performed | No | No | three weekly doses of injection benzathine penicillin 2.4 MU | No | Good clinical outcome |
Alcedo et al. [8] | 453 | 140 | NR*1/Positive | Yes, normal, VDRL 1:2, PCR not performed | Yes, immunostaining and PCR not performed | No | No | IV penicillin G sodium 16 MU/day for 14 days | Yes, corticosteroid therapy for 14 days | Good clinical outcome |
Yap et al. [7] | 65 | 252 | Positive/Positive | No | Yes, immunostaining not performed and PCR positive | Vitreous biopsy, PCR positive | No | IV benzylpenicillin 1.8 g q.i.d. for 15 days in addition to 60-mg prednisolone for 5 days to prevent a Jarisch–Herxheimer reaction | No | Good clinical outcome |
Frunza-Stefan et al. [11] | 5000 | 257 | Positive/Positive | Yes, normal, VDRL negative, PCR not performed | Yes, immunostaining positive, PCR not performed | No | No | three weekly doses of injection benzathine penicillin 2.4 MU | Yes, non-steroid anti-inflammatory drugs | Good clinical outcome |
Braue et al. [4] | NR*1 | 450 | Positive/Positive | Yes, normal, serology negative, PCR not performed | Yes, immunostaining negative, PCR not performed | Biopsy of the terminal ileum and of a rectal mass and lymph node biopsies | Yes, CT | IV penicillin G 24 MU daily for two weeks and an additional three weekly doses of injection benzathine penicillin 2.4 MU | No | Good clinical outcome |
Khatri et al. [12] | 130 | 154 | NR/Positive | Yes, pleocytosis VDRL negative PCR not performed | Yes, Immunostaining negative, PCR not performed | No | No | Treated for neurosyphilis, (CSF pleocytosis), therapy not indicated | No | Good clinical outcome |
Vasudevan et al. [9] | 10,000 | 196 | Positive/Positive | Yes normal, VDRL negative, PCR not performed | Yes, immunostaining and PCR not performed | No | No | Single dose of 2.4 MU of benzathine penicillin | No | Good clinical outcome |
Bernal et al. [13] | < 50 | 280 | Positive/Positive | Yes, normal, VDRL negative, PCR not performed | No | Puncture of the aqueous humor | Yes, CT | 2 g of IV ceftriaxone for 2 weeks | No | Slight visual impairment |
Hardwick et al. [14] | NR | NR | Positive/Positive | No | No | No | No | Injection of procaine penicillin for 17 days | Yes, Montelukast 10 mg daily for 5 months | Good clinical outcome |
Moloney et al. [15] | NR | 340 | NR/Positive | Yes, pleocytosis and elevated protein, VDRL < 1:2, PCR negative | No | Vitreous biopsy, PCR positive | Yes, CT and MRI | IV benzylpenicillin 2.4 g 4-hourly for 14 days | No | Good clinical outcome |
Brochard et al. [16] | 1000 | 329 | Positive/Positive | Yes, normal, VDRL negative, PCR not performed | Yes, immunostaining positive and PCR negative | Joint Aspiration, PCR positive | No | IV benzylpenicillin for 14 days | No | Good clinical outcome |
Ceccarelli et al. [17] | 0 | 227 | Positive/Positive | Yes, normal, serology negative, PCR not performed | No | No | Yes, MRI | IV penicillin G 2.4 MU for 14 days and an additional three weekly doses of injection benzathine | Yes, Prednisone 25 mg/die for 14 days | Left eye vision was lost and right visual acuity was 7/10 |
penicillin 2.4 MU | ||||||||||
Rushing et al. [5] | < 50 | 43 | Positive/Positive | Yes, Normal, VDRL negative, PCR negative | No | Brain biopsy | Yes, MRI | IV penicillin G for 14 days | No | Good clinical outcome |
Bucher et al. [6] | 922 | 177 | Positive/Positive | Yes, pleocytosis and increased CSF total protein levels, VDRL reactive, PCR not performed | No | No | Yes, CT and MRI | IV penicillin G 24 MU daily for two weeks and an additional three weekly doses of injection benzathine penicillin 2.4 MU | No | After one-year neurologic examination showed mild left-sided weakness |
Our case | 42 | 318 | Positive/Positive | Yes, pleocytosis and increased CSF total protein levels, RPR negative, PCR negative | No | No | Yes, CT and MRI | IV penicillin G 2.4 MU for 14 days | No | Slight visual impairment |