Immune reconstitution syndrome–induced hypercalcemic crisis

• Published in: The American journal of emergency medicine Vol. 29; no. 2; pp. 244.e3 - 244.e6
• Main Authors: Tsao, Yu-Tzu, Wu, Chia-Chao, Chu, Pauling
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2011; Elsevier Limited
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Antitubercular Agents - administration & dosage; Antitubercular Agents - therapeutic use; Emergency; Emergency medical care; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; HIV-1; Human immunodeficiency virus; Humans; Hypercalcemia - drug therapy; Hypercalcemia - etiology; Hypercalcemia - virology; Immune Reconstitution Inflammatory Syndrome - complications; Immune Reconstitution Inflammatory Syndrome - drug therapy; Immune Reconstitution Inflammatory Syndrome - virology; Immune status; Male; Mediastinum - microbiology; Mediastinum - pathology; Middle Aged; Mortality; Tuberculosis; Tuberculosis, Lymph Node - complications; Tuberculosis, Lymph Node - drug therapy; Tuberculosis, Lymph Node - immunology; Tuberculosis, Lymph Node - virology; Vitamin D; Vitamin D - administration & dosage; Vitamin D - therapeutic use
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2010.03.013

[...]highly active antiretroviral therapy (HAART) with stavudine, lamivudine, and efavirenz was started without major adverse events. Interestingly, trends in CD4 cell count were observed that it increased in vitamin D-treated subjects who were not HIV infected but decreased in HIV-infected patients, indicating the question of whether vitamin D has a differential effect depending on immune status. [...]the critical role of 1,25(OH)2D3 manifesting a local positive feedback defense mechanism from restored granulomatous response in IRS and a systemic negative feedback immune inhibition in the presence of chronic HIV infection should be further clarified.