Neurologic immune reconstitution inflammatory syndrome in HIV/AIDS
Bibliographic record
Abstract
OBJECTIVE: To characterize the immune reconstitution inflammatory syndrome in the nervous system (NeuroIRIS) among patients with HIV/AIDS. BACKGROUND: NeuroIRIS has been recognized as a complication of combination antiretroviral therapy (cART). METHODS: A retrospective analysis was performed of NeuroIRIS patients fulfilling diagnostic criteria and followed at the Northern or Southern Alberta (HIV) Clinics. A nested epidemiologic study was performed within a subset of patients in whom cART was started from 1999 to 2007. RESULTS: NeuroIRIS was diagnosed in seven patients initiating cART. All were men (median age, 35 years) and exhibited severe immunosuppression (median CD4(+) T cells, 30 cells/mm(3)). Four patients presented to the Southern Alberta Clinic, representing all NeuroIRIS cases among 461 patients in whom cART was initiated over an 8-year period (incidence 0.9%). New onset of neurologic deterioration (n = 4) or worsening of prior neurologic disabilities (n = 3) due to progressive multifocal leukoencephalopathy, toxoplasmic encephalitis, and cryptococcal meningitis occurred between 2 to 25 weeks after the initiation of cART. All patients demonstrated a robust increase in blood CD4(+) T-cell count in response to cART. A brain biopsy in one patient revealed inflammation and necrosis together with CD68(+) macrophage and CD8(+) T-cell infiltrates, which were also CD40 and CD154 immunoreactive. Two patients received corticosteroids as treatment for NeuroIRIS with an overall survival of 86%, while 14% exhibited fixed neurologic disabilities. CONCLUSIONS: Immune reconstitution inflammatory syndrome in the nervous system (NeuroIRIS) remains an uncommon complication of combination antiretroviral therapy (cART) but with a potentially poor outcome. Initiation of cART in very immunosuppressed patients requires close monitoring to manage NeuroIRIS in an expedient manner.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".