PMID- 18317001
OWN - NLM
STAT- MEDLINE
DCOM- 20080715
LR  - 20211020
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 22
IP  - 5
DP  - 2008 Mar 12
TI  - Incidence and risk factors for the immune reconstitution inflammatory syndrome in 
      HIV patients in South Africa: a prospective study.
PG  - 601-10
LID - 10.1097/QAD.0b013e3282f4a607 [doi]
AB  - OBJECTIVE: To determine the incidence, clinical manifestations, risk factors and 
      outcome of immune reconstitution inflammatory syndrome (IRIS) in South Africa. 
      DESIGN: Prospective surveillance cohort and nested case-control study in a large, 
      University hospital-based antiretroviral therapy (ART) clinic. METHODS: A total 
      of 423 ART-naive HIV-infected South African patients were followed for signs and 
      symptoms IRIS during the first 6 months of ART. We also performed a nested 
      case-control study with controls matched to IRIS cases on ART duration. RESULTS: 
      During the first 6 months of ART, 44 (10.4%) patients experienced IRIS for an 
      overall incidence rate of 25.1 cases per 100 patient-years. Diagnoses included 
      tuberculosis (18/44, 41%), abscess formation and suppurative folliculitis (8/44, 
      18.2%), varicella zoster (6/44, 13.6%), herpes simplex (4/44, 9.1%), cryptococcal 
      meningitis (3/44, 6.8%), molluscum contagiosum (3/44, 6.8%), and Kaposi's sarcoma 
      (2/44, 4.5%). Median IRIS onset was 48 days (interquartile range, 29-99) from ART 
      initiation. In comparison with controls, IRIS cases had significantly lower CD4 
      cell counts at baseline (79 versus 142 cells/microl; P = 0.02) and at IRIS 
      diagnosis (183 versus 263 cells/microl; P = 0.05), but similar virological and 
      immunological response to ART. In multivariable analyses, higher baseline CD4 
      cell count was protective of developing IRIS (HR 0.72 per 50 cells/microl 
      increase). Most IRIS cases were mild, with ART discontinued in three (6.8%) 
      patients, corticosteroids administered to four (9.1%) patients, and 
      hospitalization required in 12 (27.3%) patients. Two deaths were attributable to 
      IRIS. CONCLUSIONS: IRIS may affect 10% of patients initiating ART in Africa, 
      particularly those with advanced immunosuppression, but severe, life-threatening 
      IRIS is uncommon.
FAU - Murdoch, David M
AU  - Murdoch DM
AD  - Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, 
      Durham, North Carolina NC 27710, USA. dmurdoch@email.unc.edu
FAU - Venter, Willem D F
AU  - Venter WD
FAU - Feldman, Charles
AU  - Feldman C
FAU - Van Rie, Annelies
AU  - Van Rie A
LA  - eng
GR  - K01 TW008005/TW/FIC NIH HHS/United States
GR  - P30AI50410/AI/NIAID NIH HHS/United States
GR  - D71TW06906/TW/FIC NIH HHS/United States
GR  - RR00046/RR/NCRR NIH HHS/United States
GR  - P30 AI050410/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
CIN - AIDS. 2008 Mar 12;22(5):643-5. PMID: 18317006
MH  - Adult
MH  - Anti-Retroviral Agents/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Case-Control Studies
MH  - Female
MH  - HIV Infections/drug therapy/*immunology/mortality
MH  - Humans
MH  - Immune Reconstitution Inflammatory 
      Syndrome/complications/*epidemiology/immunology
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Factors
MH  - South Africa
MH  - Survival Analysis
MH  - Time Factors
EDAT- 2008/03/05 09:00
MHDA- 2008/07/17 09:00
CRDT- 2008/03/05 09:00
PHST- 2008/03/05 09:00 [pubmed]
PHST- 2008/07/17 09:00 [medline]
PHST- 2008/03/05 09:00 [entrez]
AID - 00002030-200803120-00006 [pii]
AID - 10.1097/QAD.0b013e3282f4a607 [doi]
PST - ppublish
SO  - AIDS. 2008 Mar 12;22(5):601-10. doi: 10.1097/QAD.0b013e3282f4a607.