Mycobacterium avium complex immune reconstitution inflammatory syndrome: long term outcomes.
BACKGROUND
To describe long term outcomes of Mycobacterium avium complex (MAC) immune reconstitution inflammatory syndrome (IRIS).


METHODS
Cases of MAC IRIS were retrospectively identified at four HIV clinics (Michigan, Maryland, Rhode Island, and Indiana) from 1996-2004. Patients were included if they were initially diagnosed with AIDS and found to have evidence of focal MAC infection documented by tissue culture or PCR after initiating HAART, and at least 6 months of follow up.


RESULTS
Among the 20 patients included, the mean age was 40 years, mean CD4 cell count was 24/mm3 at pretreatment baseline and 100/mm3 at time of MAC IRIS diagnosis. Sites of disease included lymph nodes (15 patients [8 peripheral, 8 abdominal and 1 peripheral and abdominal]), gastrointestinal tract (7) and liver (3). Sixteen patients (80%) responded to treatment and were disease free after a mean of 17.4 months of therapy for MAC IRIS; IRIS therapy was withdrawn in 6 without relapse. Four patients (non-responder group) had persistent or relapsing disease despite 27 months of ongoing MAC IRIS treatment. At the time of resolution or last follow-up, the mean CD4 cell count and viral load was 143/mm3 and 7,000 c/mL for responders, and 65/mm3 and 17,000 c/mL for non-responders, respectively. Most patients with peripheral adenopathy were responders (7/8; 88%); many with abdominal adenopathy (4/8; 50%) were nonresponders.


CONCLUSIONS
The majority of patients with MAC IRIS eventually responded to treatment. Our sample size was not adequate to perform statistical analysis, but there was a tendency towards adequate CD4 response to HAART and peripheral rather than intraabdominal adenopathy among responders.
Riddell
James
J
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA. jriddell@umich.edu
Kaul
Daniel R
DR
Karakousis
Petros C
PC
Gallant
Joel E
JE
Mitty
Jennifer
J
Kazanjian
Powel H
PH
D000038:Abscess; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007249:Inflammation / Q000382:microbiology*; D008198:Lymph Nodes / Q000382:microbiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000378:metabolism*; D009162:Mycobacterium avium / Q000378:metabolism*; D013577:Syndrome; D016896:Treatment Outcome
D000890:Anti-Infective Agents