title: Impact of the immune reconstitution inflammatory syndrome (IRIS) on mortality and morbidity in HIV-infected patients in Mexico.
abstract: OBJECTIVE
  To estimate the impact of immune reconstitution inflammatory syndrome (IRIS) on morbidity and mortality in patients starting highly-active antiretroviral therapy (HAART).
  
  
  METHODS
  A retrospective cohort study of HIV-positive patients starting HAART was conducted at a tertiary care referral center in Mexico City. We estimated the incidence of IRIS, hospitalizations and death rates during the first 2 years of HAART. The relative risk of death (RR) and hospitalization for patients with IRIS were adjusted for relevant covariates using regression methods.
  
  
  RESULTS
  During the 2-year follow-up period, 27% of patients developed IRIS (14 IRIS cases per 100 person-years). The relative risk of death among patients who developed IRIS was 3 times higher (95% confidence interval (CI) 1.19-7.65, p = 0.03). After adjusting for previous opportunistic infections we still observed a higher death rate among patients with IRIS (RR 2.3, 95% CI 0.9-5.9, p=0.09). An effect modification of IRIS over mortality was observed by previous opportunistic infection.
  
  
  CONCLUSIONS
  IRIS-associated mortality is strongly confounded by previous opportunistic infection. Patients with AIDS who eventually developed IRIS had the highest risk of death at the 2-year follow-up.
authors.affiliation: Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico.
authors.forename: Irma
authors.initials: I
authors.lastname: Hoyo-Ulloa
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Belaunzarán-Zamudio
authors.forename: Brenda
authors.initials: B
authors.lastname: Crabtree-Ramirez
authors.forename: Arturo
authors.initials: A
authors.lastname: Galindo-Fraga
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Pérez-Aguinaga
authors.forename: Juan G
authors.initials: JG
authors.lastname: Sierra-Madero
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D015497:HIV-1 / Q000276:immunology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D015994:Incidence; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors