Promise and Challenges of Checkpoint Inhibitor Therapy for Progressive Multifocal Leukoencephalopathy in HIV.

IF 3.7 2区医学 Q2 INFECTIOUS DISEASES

Current HIV/AIDS Reports Pub Date : 2022-12-01 Epub Date: 2022-10-01 DOI:10.1007/s11904-022-00626-w

Sydney Corey, Bryan R Smith, Irene C M Cortese

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Abstract

Purpose of review: Progressive multifocal leukoencephalopathy (PML) is a severe opportunistic infection that remains an important cause of morbidity and mortality in people living with HIV (PLWH). Immune checkpoint molecules are negative regulators of the immune response that have been targeted as a strategy to bolster anti-viral immunity in PML, with varied outcomes reported. While initiation and optimization of antiretroviral therapy remains the standard of care in HIV-related PML, the specific opportunities and risks for checkpoint blockade in these cases should be explored.

Recent findings: As of April 15, 2022, only 5 of the 53 total published cases of PML treated with checkpoint blockade had underlying HIV infection; four of these had a favorable outcome. The risk of promoting immune reconstitution inflammatory syndrome is a major concern and underscores the importance of patient selection and monitoring. Checkpoint blockade warrants further exploration as a potentially promising option for treatment escalation in HIV-related PML.

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检查点抑制剂疗法治疗艾滋病进行性多灶性白质脑病的前景与挑战。

综述的目的：进行性多灶性白质脑病（PML）是一种严重的机会性感染，仍然是艾滋病毒感染者（PLWH）发病和死亡的重要原因。免疫检查点分子是免疫反应的负调控因子，已被作为加强 PML 抗病毒免疫的靶点，但报道的结果各不相同。虽然启动和优化抗逆转录病毒疗法仍是治疗艾滋病相关 PML 的标准，但应探讨在这些病例中使用检查点阻断疗法的具体机会和风险：截至2022年4月15日，在已发表的53例接受检查点阻断治疗的PML病例中，只有5例存在潜在的HIV感染；其中4例的治疗结果良好。促进免疫重建炎症综合征的风险是一个主要问题，并强调了患者选择和监测的重要性。检查点阻断疗法作为HIV相关PML治疗升级的一种潜在可行方案，值得进一步探索。

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来源期刊

Current HIV/AIDS Reports INFECTIOUS DISEASES-

CiteScore

8.10

自引率

2.20%

发文量

期刊介绍： This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of HIV/AIDS. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antiretroviral therapies, behavioral aspects of management, and metabolic complications and comorbidity. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.