title: Steroids are a risk factor for Kaposi's sarcoma-immune reconstitution inflammatory syndrome and mortality in HIV infection.
abstract: OBJECTIVE
  To investigate the association between Kaposi's sarcoma-associated immune reconstitution inflammatory syndrome (KS-IRIS) and mortality, with the use of glucocorticoids in HIV-infected individuals.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  We reviewed the medical records of 145 individuals with HIV-associated Kaposi's sarcoma receiving antiretroviral therapy. The association of different variables with KS-IRIS and Kaposi's sarcoma-related mortality was explored by univariate and multivariate analyses. The main exposure of interest was the use of glucocorticoids. We also compared the time to KS-IRIS and the time to death of individuals treated with glucocorticoids vs. those nontreated with glucocorticoids, and the time to death of individuals with KS-IRIS vs. those without KS-IRIS by hazards regression.
  
  
  RESULTS
  Sixty of 145 individuals received glucocorticoids (41.4%) for the management or suspicion of Pneumocystis jirovecii pneumonia. Fifty individuals had KS-IRIS (37%). The use of glucocorticoids was more frequent in individuals with KS-IRIS than in those without KS-IRIS (54.9 vs. 36.47%, P = 0.047). Kaposi's sarcoma-related mortality occurred in 17 cases (11.7%), and glucocorticoid use was more frequent in this group (76.47 vs. 36.7%, P = 0.003). Glucocorticoid use was a risk factor for mortality (adjusted odds ratio = 4.719, 95% confidence interval = 1.383-16.103, P = 0.0132), and was associated with shorter periods to KS-IRIS (P = 0.03) and death (P = 0.0073). KS-IRIS was a risk factor for mortality (P = 0.049).
  
  
  CONCLUSIONS
  In HIV-infected individuals, the use of glucocorticoids is a risk factor for KS-IRIS and Kaposi's sarcoma-associated mortality. In addition, KS-IRIS is a risk factor for mortality. Therefore, glucocorticoid administration in this population requires careful consideration based on individualized risk-benefit analysis.
authors.affiliation: Departamento de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico.
authors.forename: Mónica
authors.initials: M
authors.lastname: Fernández-Sánchez
authors.forename: María C
authors.initials: MC
authors.lastname: Iglesias
authors.forename: Yuria
authors.initials: Y
authors.lastname: Ablanedo-Terrazas
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Ormsby
authors.forename: Claudia
authors.initials: C
authors.lastname: Alvarado-de la Barrera
authors.forename: Gustavo
authors.initials: G
authors.lastname: Reyes-Terán
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology / Q000401:mortality*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000453:epidemiology / Q000401:mortality*; D013256:Steroids / Q000627:therapeutic use*; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids