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Paradoxical Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patients Treated With Combination Antiretroviral Therapy After AIDS-Defining Opportunistic Infection

By Chad J. Achenbach, Robert D. Harrington, Shireesha Dhanireddy, Heidi M. Crane, Corey Casper and Mari M. Kitahata

Abstract

Background. The incidence of immune reconstitution inflammatory syndrome (IRIS) when antiretroviral therapy (ART) is initiated after an AIDS-defining opportunistic infection (OI) is uncertain and understudied for the most common OIs. Methods. We examined patients in the University of Washington Human Immunodeficiency Virus Cohort initiating potent ART subsequent to an AIDS-defining OI. IRIS was determined through retrospective medical record review and adjudication using a standardized data collection process and clinical case definition. We compared demographic and clinical characteristics, and immunologic changes in patients with and without IRIS. Results. Among 196 patients with 260 OIs, 21 (11%; 95 % confidence interval, 7%–16%) developed paradoxical IRIS in the first year on ART. The 3 most common OIs among study patients were Pneumocystis pneumonia (PCP, 28%), Candida esophagitis (23%), and Kaposi sarcoma (KS, 16%). Cumulative 1-year incidence of IRIS was 29% (12/41) for KS, 16 % (4/25) for tuberculosis, 14 % (1/7) for Cryptococcus, 10 % (1/10) for Mycobacterium avium complex, and 4 % (3/72) for PCP. Morbidity and mortality were highest in those with visceral KS-IRIS compared with other types of IRIS (100 % [6/6] vs 7 % [1/15], P,.01). Patients with mucocutaneous KS and tuberculosis-IRIS experienced greater median increase in CD41 cell count during the first 6 months of ART compared with those without IRIS (1158 vs 153 cells/lL, P 5.04, mucocutaneous KS; 1261 vs 1113, P 5.04

Year: 2016
OAI identifier: oai:CiteSeerX.psu:10.1.1.1019.2232
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