Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy

Samuel A. Shelburne, Fehmida Visnegarwala, Jorge Darcourt, Edward A. Graviss, Thomas P. Giordano, A. Clinton White, Richard J. Hamill

Research output: Contribution to journalArticle

504 Citations (Scopus)

Abstract

Background: There is little systematic information regarding the immune reconstitution inflammatory syndrome (IRIS). Objective: To determine the incidence, risk factors, and long-term outcome of IRIS in HIV-infected patients receiving highly active antiretroviral therapy (HAART) who were coinfected with one of three common opportunistic pathogens. Design: A retrospective cohort identified through a city-wide prospective surveillance program. Methods: A retrospective chart review was performed for 180 HIV-infected patients who received HAART and were coinfected with Mycobacterium tuberculosis, Mycobacterium avium complex, or Cryptococcus neoformans between 1997 and 2000. Medical records were reviewed for baseline demographics, receipt and type of HAART, response to antiretroviral therapy, development of IRIS, and long-term outcome. Results: In this cohort, 31.7% of patients who received HAART developed IRIS. Patients with IRIS were more likely to have initiated HAART nearer to the time of diagnosis of their opportunistic infection (P < 0.001), to have been antiretroviral naive at time of diagnosis of their opportunistic infection (P < 0.001), and to have a more rapid initial fall in HIV-1 RNA level in response to HAART (P < 0.001). Conclusions: IRIS is common among HIV-infected persons coinfected with M. tuberculosis, M. avium complex, or C. neoformans. Antiretroviral drug-naive patients who start HAART in close proximity to the diagnosis of an opportunistic infection and have a rapid decline in HIV-1 RNA level should be monitored for development of this disorder.

Original languageEnglish (US)
Pages (from-to)399-406
Number of pages8
JournalAIDS
Volume19
Issue number4
StatePublished - Mar 4 2005
Externally publishedYes

Fingerprint

Immune Reconstitution Inflammatory Syndrome
Highly Active Antiretroviral Therapy
Incidence
Opportunistic Infections
Mycobacterium avium Complex
Cryptococcus neoformans
HIV
Mycobacterium tuberculosis
HIV-1
RNA
Medical Records
Demography

Keywords

  • HAART
  • HIV
  • Immune reconstitution inflammatory syndrome
  • Incidence
  • Opportunistic infections
  • Risk factors

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Shelburne, S. A., Visnegarwala, F., Darcourt, J., Graviss, E. A., Giordano, T. P., White, A. C., & Hamill, R. J. (2005). Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS, 19(4), 399-406.

Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. / Shelburne, Samuel A.; Visnegarwala, Fehmida; Darcourt, Jorge; Graviss, Edward A.; Giordano, Thomas P.; White, A. Clinton; Hamill, Richard J.

In: AIDS, Vol. 19, No. 4, 04.03.2005, p. 399-406.

Research output: Contribution to journalArticle

Shelburne, SA, Visnegarwala, F, Darcourt, J, Graviss, EA, Giordano, TP, White, AC & Hamill, RJ 2005, 'Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy', AIDS, vol. 19, no. 4, pp. 399-406.
Shelburne SA, Visnegarwala F, Darcourt J, Graviss EA, Giordano TP, White AC et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS. 2005 Mar 4;19(4):399-406.
Shelburne, Samuel A. ; Visnegarwala, Fehmida ; Darcourt, Jorge ; Graviss, Edward A. ; Giordano, Thomas P. ; White, A. Clinton ; Hamill, Richard J. / Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. In: AIDS. 2005 ; Vol. 19, No. 4. pp. 399-406.
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abstract = "Background: There is little systematic information regarding the immune reconstitution inflammatory syndrome (IRIS). Objective: To determine the incidence, risk factors, and long-term outcome of IRIS in HIV-infected patients receiving highly active antiretroviral therapy (HAART) who were coinfected with one of three common opportunistic pathogens. Design: A retrospective cohort identified through a city-wide prospective surveillance program. Methods: A retrospective chart review was performed for 180 HIV-infected patients who received HAART and were coinfected with Mycobacterium tuberculosis, Mycobacterium avium complex, or Cryptococcus neoformans between 1997 and 2000. Medical records were reviewed for baseline demographics, receipt and type of HAART, response to antiretroviral therapy, development of IRIS, and long-term outcome. Results: In this cohort, 31.7{\%} of patients who received HAART developed IRIS. Patients with IRIS were more likely to have initiated HAART nearer to the time of diagnosis of their opportunistic infection (P < 0.001), to have been antiretroviral naive at time of diagnosis of their opportunistic infection (P < 0.001), and to have a more rapid initial fall in HIV-1 RNA level in response to HAART (P < 0.001). Conclusions: IRIS is common among HIV-infected persons coinfected with M. tuberculosis, M. avium complex, or C. neoformans. Antiretroviral drug-naive patients who start HAART in close proximity to the diagnosis of an opportunistic infection and have a rapid decline in HIV-1 RNA level should be monitored for development of this disorder.",
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N2 - Background: There is little systematic information regarding the immune reconstitution inflammatory syndrome (IRIS). Objective: To determine the incidence, risk factors, and long-term outcome of IRIS in HIV-infected patients receiving highly active antiretroviral therapy (HAART) who were coinfected with one of three common opportunistic pathogens. Design: A retrospective cohort identified through a city-wide prospective surveillance program. Methods: A retrospective chart review was performed for 180 HIV-infected patients who received HAART and were coinfected with Mycobacterium tuberculosis, Mycobacterium avium complex, or Cryptococcus neoformans between 1997 and 2000. Medical records were reviewed for baseline demographics, receipt and type of HAART, response to antiretroviral therapy, development of IRIS, and long-term outcome. Results: In this cohort, 31.7% of patients who received HAART developed IRIS. Patients with IRIS were more likely to have initiated HAART nearer to the time of diagnosis of their opportunistic infection (P < 0.001), to have been antiretroviral naive at time of diagnosis of their opportunistic infection (P < 0.001), and to have a more rapid initial fall in HIV-1 RNA level in response to HAART (P < 0.001). Conclusions: IRIS is common among HIV-infected persons coinfected with M. tuberculosis, M. avium complex, or C. neoformans. Antiretroviral drug-naive patients who start HAART in close proximity to the diagnosis of an opportunistic infection and have a rapid decline in HIV-1 RNA level should be monitored for development of this disorder.

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