TY - JOUR
T1 - Immune reconstitution inflammatory syndrome
T2 - Incidence and implications for mortality
AU - Novak, Richard M.
AU - Richardson, James T.
AU - Buchacz, Kate
AU - Chmiel, Joan S.
AU - Durham, Marcus D.
AU - Palella, Frank J.
AU - Wendrow, Andrea
AU - Wood, Kathy
AU - Young, Benjamin
AU - Brooks, John T.
AU - Baker, Rose K.
AU - Hankerson, Darlene
AU - Armon, Carl
AU - Studney, Carolyn
AU - Enyia, Onyinye
AU - Lichtenstein, Kenneth A.
AU - Stewart, Cheryl
AU - Hammer, John
AU - Greenberg, Kenneth S.
AU - Widick, Barbara
AU - Axinn, Joslyn D.
AU - Yangco, Bienvenido G.
AU - Halkias, Kalliope
AU - Ward, Douglas J.
AU - Miller, Jay
AU - Fuhrer, Jack
AU - Ording-Bauer, Linda
AU - Kelly, Rita
AU - Esteves, Jane
AU - Tedaldi, Ellen M.
AU - Christian, Ramona A.
AU - Ruley, Faye
AU - Beadle, Dania
PY - 2012/3/27
Y1 - 2012/3/27
N2 - OBJECTIVE: To describe incidence of immune reconstitution inflammatory syndrome (IRIS) and its association with mortality in a large multisite US HIV-infected cohort applying an objective, comprehensive definition. DESIGN: We studied 2 610 patients seen during 1996-2007 who initiated or resumed highly active combination antiretroviral therapy (cART) and, during the next 6 months, demonstrated a decline in plasma HIV-RNA viral load of at least 0.5 log10 copies/ml or an increase of at least 50% in CD4 cell count per microliter. We defined IRIS as the diagnosis of a type B or C condition [as per the Centers for Disease Control and Prevention (CDC) 1993 AIDS case definition] or any new mucocutaneous disorder during this same 6-month period. METHODS: We assessed the incidence of IRIS and evaluated risk factors for IRIS using conditional logistic regression and for all-cause mortality using proportional hazards models. RESULTS: We identified 370 cases of IRIS (in 276 patients). Median and nadir CD4 cell counts at cART initiation were 90 and 43 cells/μl, respectively; median viral load was 2.7 log10 copies/ml. The most common IRIS-defining diagnoses were candidiasis (all forms), cytomegalovirus infection, disseminated Mycobacterium avium intracellulare, Pneumocystis pneumonia, varicella zoster, Kaposi's sarcoma and non-Hodgkin lymphoma. Only one case of Mycobacterium tuberculosis was observed. IRIS was independently associated with CD4 cell count less than 50 cells/μl vs. at least 200 cells/μl [odds ratio (OR) 5.0] and a viral load of at least 5.0 log10 copies vs. less than 4.0 log10 copies (OR 2.3). IRIS with a type B-defining or type C-defining diagnosis approximately doubled the risk for all-cause mortality. CONCLUSION: In this large US-based HIV-infected cohort, IRIS occurred in 10.6% of patients who responded to effective ART and contributed to increased mortality.
AB - OBJECTIVE: To describe incidence of immune reconstitution inflammatory syndrome (IRIS) and its association with mortality in a large multisite US HIV-infected cohort applying an objective, comprehensive definition. DESIGN: We studied 2 610 patients seen during 1996-2007 who initiated or resumed highly active combination antiretroviral therapy (cART) and, during the next 6 months, demonstrated a decline in plasma HIV-RNA viral load of at least 0.5 log10 copies/ml or an increase of at least 50% in CD4 cell count per microliter. We defined IRIS as the diagnosis of a type B or C condition [as per the Centers for Disease Control and Prevention (CDC) 1993 AIDS case definition] or any new mucocutaneous disorder during this same 6-month period. METHODS: We assessed the incidence of IRIS and evaluated risk factors for IRIS using conditional logistic regression and for all-cause mortality using proportional hazards models. RESULTS: We identified 370 cases of IRIS (in 276 patients). Median and nadir CD4 cell counts at cART initiation were 90 and 43 cells/μl, respectively; median viral load was 2.7 log10 copies/ml. The most common IRIS-defining diagnoses were candidiasis (all forms), cytomegalovirus infection, disseminated Mycobacterium avium intracellulare, Pneumocystis pneumonia, varicella zoster, Kaposi's sarcoma and non-Hodgkin lymphoma. Only one case of Mycobacterium tuberculosis was observed. IRIS was independently associated with CD4 cell count less than 50 cells/μl vs. at least 200 cells/μl [odds ratio (OR) 5.0] and a viral load of at least 5.0 log10 copies vs. less than 4.0 log10 copies (OR 2.3). IRIS with a type B-defining or type C-defining diagnosis approximately doubled the risk for all-cause mortality. CONCLUSION: In this large US-based HIV-infected cohort, IRIS occurred in 10.6% of patients who responded to effective ART and contributed to increased mortality.
KW - HAART
KW - HIV
KW - United States
KW - immune reconstitution inflammatory syndrome
KW - mortality
KW - opportunistic infections
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=84862811555&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862811555&partnerID=8YFLogxK
U2 - 10.1097/QAD.0b013e3283511e91
DO - 10.1097/QAD.0b013e3283511e91
M3 - Article
C2 - 22233655
AN - SCOPUS:84862811555
VL - 26
SP - 721
EP - 730
JO - AIDS
JF - AIDS
SN - 0269-9370
IS - 6
ER -