Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy.
BACKGROUND
There is little systematic information regarding the immune reconstitution inflammatory syndrome (IRIS).


OBJECTIVE
To determine the incidence, risk factors, and long-term outcome of IRIS in HIV-infected patients receiving highly active antiretroviral therapy (HAART) who were coinfected with one of three common opportunistic pathogens.


METHODS
A retrospective cohort identified through a city-wide prospective surveillance program.


METHODS
A retrospective chart review was performed for 180 HIV-infected patients who received HAART and were coinfected with Mycobacterium tuberculosis, Mycobacterium avium complex, or Cryptococcus neoformans between 1997 and 2000. Medical records were reviewed for baseline demographics, receipt and type of HAART, response to antiretroviral therapy, development of IRIS, and long-term outcome.


RESULTS
In this cohort, 31.7% of patients who received HAART developed IRIS. Patients with IRIS were more likely to have initiated HAART nearer to the time of diagnosis of their opportunistic infection (P < 0.001), to have been antiretroviral naive at time of diagnosis of their opportunistic infection (P < 0.001), and to have a more rapid initial fall in HIV-1 RNA level in response to HAART (P < 0.001).


CONCLUSIONS
IRIS is common among HIV-infected persons coinfected with M. tuberculosis, M. avium complex, or C. neoformans. Antiretroviral drug-naive patients who start HAART in close proximity to the diagnosis of an opportunistic infection and have a rapid decline in HIV-1 RNA level should be monitored for development of this disorder.
Shelburne
Samuel A
SA
Department of Medicine, Section of Infectious Diseases, University of Texas Health Science Center at Houston, Texas 77030-4211, USA.
Visnegarwala
Fehmida
F
Darcourt
Jorge
J
Graviss
Edward A
EA
Giordano
Thomas P
TP
White
A Clinton
AC
Hamill
Richard J
RJ
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000276:immunology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000209:etiology*; D013781:Texas / Q000453:epidemiology; D019562:Viral Load
D012367:RNA, Viral