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

  title={Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy},
  author={Samuel A. Shelburne and Fehmida Visnegarwala and Jorge G Darcourt and Edward A. Graviss and Thomas P. Giordano and A Clinton White and Richard J. Hamill},
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… 

Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort.

Patients with advanced immunodeficiency at HAART initiation are at greatest risk of developing IRIS and should be appropriately screened and monitored.

Immune Reconstitution Inflammatory Syndrome during the First Six Months of Receiving Antiretroviral in HIV-Infected Individuals: A Retrospective Study

This study found relatively low prevalence of IRIS among patients attending care and treatment clinic at Muhimbili National Hospital, and poor adherence to HAART was found to be a risk factor for IRIS.

Paradoxical immune reconstitution inflammatory syndrome in HIV-infected patients treated with combination antiretroviral therapy after AIDS-defining opportunistic infection.

Cumulative incidence and features of IRIS varied depending on the OI, and occurred in >10% of patients with KS, tuberculosis, or Cryptococcus, while visceral KS-IRIS led to considerable morbidity and mortality.

Immune Reconstitution Inflammatory Syndrome: Risk Factors and Treatment Implications

The most immunosuppressed patients treated with the most potent regimen, particularly BPI-based regimens, resulting in significant HIV viral load declines are at greatest risk for the development of IRIS after HAART initiation.

Immune reconstitution inflammatory syndrome: incidence and implications for mortality

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 and approximately doubled the risk for all-cause mortality.

Risk Factor Analyses for Immune Reconstitution Inflammatory Syndrome in a Randomized Study of Early vs. Deferred ART during an Opportunistic Infection

Concern about IRIS should not prompt deferral of ART in patients with advanced immunosuppression and non-tuberculous OIs, and the presence of a fungal infection, lower CD4+ T-cell counts and higher HIV RNA levels at baseline, and higher CD4- T- cell counts and lower HIVRNA levels on treatment are associated with IRIS.

Risk factors for ‘unmasking immune reconstitution inflammatory syndrome’ presentation of tuberculosis following combination antiretroviral therapy initiation in HIV-infected patients

Patients with African origins, advanced HIV infection, or a strong response to cART are at greater risk of unmasking TB-IRIS.

Immune reconstitution inflammatory syndrome in HIV-infected patients with and without prior tuberculosis

In this population of HIV-infected patients, IRIS was a common event, more so among patients with prior tuberculosis, and neither the rate of CD4 increase nor the Robertson criteria were useful in predicting its development.

Immune Reconstitution Inflammatory Syndrome in Human Immunodeficiency Virus-Infected Children in Peru

IRIS occurred in 20% of HIV-infected children starting HAART in Peru and was associated with more advanced disease and malnutrition and future research is needed to examine specific risk factors associated with pediatric IRIS.



The immune reconstitution inflammatory syndrome.

A subgroup of HAART-treated patients will exhibit paradoxical deterioration in their clinical status, despite satisfactory control of viral replication and improvements in CD4 lymphocyte counts, known as the immune restoration syndrome or immune reconstitution inflammatory syndrome.

Immune Reconstitution Inflammatory Syndrome: Emergence of a Unique Syndrome During Highly Active Antiretroviral Therapy

The present understanding of the basic science underlying IRIS is reviewed, with illustrative examples from the authors' case series, and the existing clinical literature is reviewed.

Durability and predictors of success of highly active antiretroviral therapy for ambulatory HIV-infected patients

Durable response to HAART was associated with being pre-HAART therapy naive, prompt response toHAART, and single protease inhibitor-based initial HAART (indinavir or nelfinavir).

Inflammatory Reactions in HIV-1Infected Persons after Initiation of Highly Active Antiretroviral Therapy

Clinical presentations and potential mechanisms of these conditions and therapeutic methods are summarized and successful Treatments used for Opportunistic Infections in HIV-1Infected Patients after Highly Active Antiretroviral Therapy are described.

Immune dysfunction and immune restoration disease in HIV patients given highly active antiretroviral therapy.

Immune reconstitution in HIV-infected patients.

The prognosis of patients infected with human immunodeficiency virus (HIV) type 1 has dramatically improved since the advent of potent antiretroviral therapies (ARTs), which have enabled sustained

HIV combination therapy: partial immune restitution unmasking latent cryptococcal infection

In patients with advanced HIV infection, partial immune restitution induced by HAART can precipitate onset of clinically apparent meningitis in those patients with latent cryptococcal central nervous system infection or with residual cryptococCal antigen present in the cerebrospinal fluid.

Paradoxical worsening of tuberculosis in HIV-infected persons.

Par paradoxical worsening of TB occurred less frequently than in previous reports and was not associated with HAART, but appeared to be associated with an increased risk of TB relapse.

Incidence of immune recovery vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy.

It is suggested that IRV develops in a significant number of HAART-responders with CMV retinitis and is unrelated to previous cidofovir therapy.

Discontinuation of Mycobacterium avium complex prophylaxis in patients with antiretroviral therapy-induced increases in CD4+ cell count. A randomized, double-blind, placebo-controlled trial. AIDS Clinical Trials Group 362 Study Team.

Prophylaxis against Mycobacterium avium complex can safely be withdrawn or withheld in adults with HIV infection who experience increases in CD4(+) cell count while receiving antiretroviral therapy.