title: Immune reconstitution inflammatory syndrome and the influence of T regulatory cells: a cohort study in The Gambia.
abstract: OBJECTIVE
  The factors associated with the development of immune reconstitution inflammatory syndrome in HIV patients commencing antiretroviral therapy have not been fully elucidated. Using a longitudinal study design, this study addressed whether alteration in the levels of T regulatory cells contributed to the development of IRIS in a West African cohort of HIV-1 and HIV-2 patients. Seventy-one HIV infected patients were prospectively recruited to the study and followed up for six months. The patients were categorized as IRIS or non-IRIS cases following published clinical guidelines. The levels of T regulatory cells were measured using flow cytometry at baseline and all follow-up visits. Baseline cytokine levels of IL-2, IL-6, IFN-γ, TNF-α, MIP-1β, IL-1, IL-12, IL-13, and IL-10 were measured in all patients.
  
  
  RESULTS
  Twenty eight percent of patients (20/71) developed IRIS and were predominantly infected with HIV-1. Patients developing IRIS had lower nadir CD4 T cells at baseline (p = 0.03) and greater CD4 T cell reconstitution (p = 0.01) at six months post-ART. However, the development of IRIS was not influenced by the levels of T regulatory cells. Similarly, baseline cytokine levels did not predict the onset of IRIS.
  
  
  CONCLUSIONS
  The development of IRIS was not associated with differences in levels of T regulatory cells or baseline pro-inflammatory cytokines.
authors: Medical Research Council (UK) Unit, Fajara, The Gambia. irfan.zaidi@gmail.com
authors: Irfan
authors: I
authors: Zaidi
authors: Kevin
authors: K
authors: Peterson
authors: David
authors: D
authors: Jeffries
authors: Hilton
authors: H
authors: Whittle
authors: Thushan
authors: T
authors: de Silva
authors: Sarah
authors: S
authors: Rowland-Jones
authors: Assan
authors: A
authors: Jaye
authors: Bouke C
authors: BC
authors: de Jong
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005714:Gambia; D015658:HIV Infections / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000378:metabolism*; D007375:Interleukin-1 / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D018664:Interleukin-12 / Q000378:metabolism; D007376:Interleukin-2 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D050378:T-Lymphocytes, Regulatory / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D007375:Interleukin-1; D007376:Interleukin-2; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D018664:Interleukin-12