Risk factors for immune reconstitution inflammatory syndrome under combination antiretroviral therapy can be aetiology-specific

In order to discriminate general from aetiology-specific risk factors for immune reconstitution inflammatory syndrome (IRIS), we followed up, during six months, 99 patients with advanced HIV infection commencing antiretroviral therapy (ART) without active opportunistic infections or evident inflamma...

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Bibliographic Details
Published in:International journal of STD & AIDS 2010-08, Vol.21 (8), p.573-579
Main Authors: Espinosa, E, Ormsby, C E, Vega-Barrientos, R S, Ruiz-Cruz, M, Moreno-Coutiño, G, Peña-Jiménez, Á, Peralta-Prado, A B, Cantoral-Díaz, M, Romero-Rodríguez, D P, Reyes-Terán, G
Format: Article
Language:English
Subjects:
Adult
AIDS/HIV
Anti-Retroviral Agents - therapeutic use
Antiretroviral Therapy, Highly Active - methods
Biological and medical sciences
CD4-CD8 Ratio
Female
General aspects
Herpesviridae - immunology
Herpesviridae - pathogenicity
Herpesviridae Infections - immunology
Herpesviridae Infections - pathology
Herpesvirus
HIV Infections - drug therapy
Human viral diseases
Humans
Immune Reconstitution Inflammatory Syndrome - epidemiology
Immune Reconstitution Inflammatory Syndrome - etiology
Immune Reconstitution Inflammatory Syndrome - microbiology
Immune Reconstitution Inflammatory Syndrome - virology
Immunopathology
Infectious diseases
Male
Medical sciences
Mycobacterium - immunology
Mycobacterium - pathogenicity
Platelet Count
Risk Factors
Tuberculosis - immunology
Tuberculosis - pathology
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:In order to discriminate general from aetiology-specific risk factors for immune reconstitution inflammatory syndrome (IRIS), we followed up, during six months, 99 patients with advanced HIV infection commencing antiretroviral therapy (ART) without active opportunistic infections or evident inflammation. IRIS predictors were determined by univariate analysis using clinical data from 76 ART-responding patients either completing follow-up or developing IRIS, and by multivariate analysis of inflammation, disease progression and nutrition status variables. We identified 23 primary IRIS events (30.3%). Univariate predictors for all IRIS events were higher platelet counts and lower CD4/CD8 ratio, whereas subclinical inflammation was the multivariate predictor. Platelets, alkaline phosphatase levels and %CD8 T-cells in univariate analysis also predicted mycobacteria-associated IRIS independently, remaining elevated during follow-up. Herpesvirus IRIS was predicted by platelets and inflammation. Indicators of advanced HIV disease and subclinical inflammation jointly predict IRIS, and some are specific of the underlying microbial aetiology, possibly explaining previous reports.
ISSN:0956-4624
1758-1052
DOI:10.1258/ijsa.2010.010135