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J Infectious Disease Med Microbiol, Volume 3
November 21-22, 2019 | Singapore
Global Experts Meeting on 12th International Conference on
STD-AIDS and
Infectious Diseases
Allergy, Immunology
and Rheumatology
Joint Event
&
allied
academies
Journal of Infectious Diseases and Medical Microbiology | Volume 3
Cryptococcal meningitis (CM) is a leading cause of death in
persons with HIV-infection worldwide and is responsible
for 15% of all AIDS deaths. Despite increasing availability of
antiretroviral therapy (ART) and anti-fungal therapy, CM
mortality remains 50-70% and continues to kill 181,000
people per year, with most deaths occurring in sub-Saharan
Africa. An important contributor to mortality in patients with
CM is HIV immune reconstitution inflammatory syndrome
(IRIS), a frequent and often deadly inflammatory reaction that
occurs after patients with advanced AIDS initiate ART due a
dysregulated inflammatory response to their infection. IRIS is
associated with CM in up to 25% of cases, withmanifestations
that include increased intracranial pressure, blindness,
deafness, cognitive dysfunction, focal neurologic deficits, or
death. InpatientswithCM, delaying initiationof ARTuntil after
6-8 weeks of effective anti-fungal therapy improves mortality
compared to immediate initiation of ART. Delaying initiation
of ART in patients with CM may prevent development of
pathological inflammatory responses associated with IRIS.
Biomarker studies evaluating cytokine expression and gene
expression in peripheral blood or CSF have shown that the
type of immune response mounted by patients with CM
can be useful to predict the development of IRIS or death.
Th2 responses, characterized by production of interleukin-4,
are associated with increased development of IRIS and
death, whereas Th1 response, characterized by high levels of
interferon-gamma, are associated with improved outcomes.
Immune therapies that promote effective responses in
patients with CMmight could improve outcomes. A challenge
to improving outcomes of CM in sub-Saharan Africa is the lack
of infrastructure and resources, and further work is needed to
optimize therapies in resource poor settings.
Speaker Biography
Paul R Bohjanen is Director of the Program in Infection and Immunity and
Professor of Medicine, Microbiology and Immunology at the University of
Minnesota, USA. He is a physician-scientist with a basic science research
interest in T cell gene regulation and a clinical interest in HIV infection. He
has engaged in collaborative research with the Infectious Diseases Institute
at Makerere University in Kampala, Uganda for the past 16 years, with
research focused on understanding the pathogenesis of HIV-associated
immune reconstitution inflammatory syndrome and cryptococcal
meningitis. He is currently working to improve outcomes of cryptococcal
meningitis in resource-poor rural settings.
e:
Paul R Bohjanen
University of Minnesota, USA
Improving outcomes of cryptococcal meningitis in Sub-Saharan
Africa
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