title: Immune reconstitution inflammatory syndrome in a resource-poor setting.
abstract: The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm(3). Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.
authors.affiliation: Section of Infectious Diseases, School of Health Sciences, University of Arizona, Tucson, Arizona 85724, USA. sklotz@u.arizona.edu
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Klotz
authors.forename: Abdul
authors.initials: A
authors.lastname: Aziz Mohammed
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Girmai Woldemichael
authors.forename: Mongistu
authors.initials: M
authors.lastname: Worku Mitku
authors.forename: Mitchell
authors.initials: M
authors.lastname: Handrich
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000209:etiology / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology* / Q000401:mortality; D008297:Male; D011203:Poverty; D012307:Risk Factors; D012720:Severity of Illness Index