Immune Reconstitution Inflammatory Syndrome in HIV-Infected Immigrants

• Published in: The American journal of tropical medicine and hygiene 2017-10, Vol.97 (4), p.1072-1077
• Main Authors: Pérez-Rueda, María, Hernández-Cabrera, Michele, Francés-Urmeneta, Adela, Angel-Moreno, Alfonso, Pisos-Álamo, Elena, Jaén-Sánchez, Nieves, Carranza-Rodríguez, Cristina, Pérez-Arellano, Jose-Luis
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - etiology; Anti-HIV Agents - therapeutic use; Emigrants and Immigrants - statistics & numerical data; Female; HIV Infections - complications; HIV Infections - epidemiology; Humans; Immune Reconstitution Inflammatory Syndrome - drug therapy; Immune Reconstitution Inflammatory Syndrome - epidemiology; Immune Reconstitution Inflammatory Syndrome - etiology; Incidence; Male; Middle Aged; Retrospective Studies; Spain - epidemiology
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.16-0773

Immune reconstitution inflammatory syndrome (IRIS) includes a group of potentially serious inflammatory processes that may be present in HIV-infected patients after initiating highly active antiretroviral therapy (HAART). is a worsening of symptoms, after an overwhelming response to a previously diagnosed opportunistic infection (OI); reveals a previously occult OI. The main objective of the study was to describe the epidemiological, clinical, and outcome data of HIV-infected immigrants, stratified according to high- or low-income countries of origin, who developed IRIS and to compare them with native-born Spanish patients. This retrospective study reviewed all patients with HIV infection admitted to the Unit of Infectious Diseases and Tropical Medicine between 1998 and 2014. IRIS was identified in 25/138 (18%) immigrant patients and 24/473 (5%) native-born Spanish patients infected with HIV. Most cases, 19/25 (76%), were of unmasking IRIS. The time elapsed between initiation of HAART and development of IRIS was significantly longer in patients with unmasking versus paradoxical IRIS. OIs, in particular due to mycobacteria, were the most frequently involved processes. Twenty percent of patients died. The comparison of immigrant and native-born patients found significant differences for both IRIS type (higher incidence of paradoxical forms among immigrants) and for the absence of malignancies in native-born patients. No significant differences were found when the data of immigrants from low- and high-income countries were compared.