title: The Epidemiology of IRIS in Southern India: An Observational Cohort Study.
abstract: Immune reconstitution inflammatory syndrome (IRIS) is an uncommon but dynamic phenomenon seen among patients initiating antiretroviral therapy (ART). We aimed to describe incidence, risk factors, clinical spectrum, and outcomes among ART-naive patients experiencing IRIS in southern India. Among 599 eligible patients monitored prospectively between 2012 and 2014, there were 59.3% males, with mean age 36.6 ± 7.8 years. Immune reconstitution inflammatory syndrome incidence rate was 51.3 per 100 person-years (95% confidence interval: 44.5-59.2). One-third (31.4%) experienced at least 1 IRIS event, at a median of 27 days since ART initiation. Mucocutaneous infections and candidiasis were common IRIS events, followed by tuberculosis. Significant risk factors included age >40 years, body mass index <18.5 kg/m2, CD4 count <100 cells/mm3, viral load >10 000 copies/mL, hemoglobin <11 g/dL, and erythrocyte sedimentation rate >50 mm/h. Immune reconstitution inflammatory syndrome-related morality was 1.3% (8 of 599); 3 patients died of complicated diarrhea. These findings highlight the current spectrum of IRIS in South India and underscore the importance of heightened vigilance for anemia and treatment of diarrhea and candidiasis during ART initiation.
authors.affiliation: 1 Department of General Surgery, Father Muller Medical College Hospital, Mangalore, Karnataka, India.
authors.forename: Nisha
authors.initials: N
authors.lastname: Thambuchetty
authors.affiliation: 2 Division of Pediatric Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kayur
authors.initials: K
authors.lastname: Mehta
authors.affiliation: 3 Division of Biostatistics, St John's Research Institute, Bangalore, Karnataka, India.
authors.forename: Karthika
authors.initials: K
authors.lastname: Arumugam
authors.affiliation: 4 Antiretroviral Treatment (ART) Centre, St John's Medical College Hospital, Bangalore, Karnataka, India.
authors.forename: Umadevi G
authors.initials: UG
authors.lastname: Shekarappa
authors.affiliation: 5 Department of Medicine, St John's Medical College, Bangalore, Karnataka, India.
authors.forename: Jyothi
authors.initials: J
authors.lastname: Idiculla
authors.affiliation: 6 International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load; D055815:Young Adult
keywords: AIDS; HIV; IRIS; anemia; candidiasis