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Case Reports
. 2006 Dec;82(6):513-4.
doi: 10.1136/sti.2005.017863.

Montelukast in the treatment of HIV associated immune reconstitution disease

C Hardwick  1 , D White, E Morris, E F Monteiro, R A Breen, M Lipman
Affiliations
Case Reports

Montelukast in the treatment of HIV associated immune reconstitution disease

C Hardwick et al. Sex Transm Infect. 2006 Dec.

Abstract

The pathogenesis of immune reconstitution disease (IRD) is not well understood and it can be difficult to manage. Leukotrienes exert proinflammatory effects, have an important role in the innate immune response, and are relatively deficient in HIV infection. Montelukast is a leukotriene receptor antagonist (LTRA) currently licensed for the treatment of asthma. We report a series of three patients with severe HIV associated IRD (cases 1 and 2 associated with starting HAART and unresponsive to steroids), who obtained clinically dramatic responses to treatment with montelukast. The first case is of IRD to secondary syphilis and the second and third to tuberculosis. Cases 1 and 3 both relapsed after a temporary break from montelukast and resolved on restarting. Montelukast should be considered in HIV associated IRD as an alternative to steroids and where these are not effective. Leukotriene overactivity may be implicated in IRD.

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Conflict of interest statement

Conflict of interest: DW has received a grant from Astra Zeneca for a study of zafirlukast (an LTRA) in recurrent vulvovaginal candidiasis

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