PMID- 19788360
OWN - NLM
STAT- MEDLINE
DCOM- 20091224
LR  - 20211028
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 49
IP  - 9
DP  - 2009 Nov 1
TI  - Defining immune reconstitution inflammatory syndrome: evaluation of expert 
      opinion versus 2 case definitions in a South African cohort.
PG  - 1424-32
LID - 10.1086/630208 [doi]
AB  - BACKGROUND: There is no validated case definition for human immunodeficiency 
      virus-associated immune reconstitution inflammatory syndrome (IRIS). We measured 
      the level of agreement of 2 published case definitions (hereafter referred to as 
      CD1 and CD2) with expert opinion in a prospective cohort of patients who were 
      starting antiretroviral therapy in South Africa. METHODS: A total of 498 adult 
      patients were monitored for the first 6 months of antiretroviral therapy. All new 
      or worsening clinical events were reviewed by 2 investigators and classified on 
      the basis of expert opinion, CD1, and CD2. Events were categorized according to 
      whether they were paradoxical or unmasking in presentation. We measured positive, 
      negative, and chance-corrected agreement (kappa) with expert opinion for CD1 and 
      CD2, and reviewed areas of disagreement. RESULTS: A total of 620 clinical events 
      were recorded, of which, on the basis of expert opinion, 144 (23.2%) were defined 
      as probable IRIS and 112 (18.1%) were defined as possible IRIS. Of the 144 
      probable IRIS events, 93 (64.6%) were unmasking in presentation, 99 (68.8%) were 
      associated with dermatological or orogenital disease, and 45 (31.3%) were 
      associated with tuberculosis or major opportunistic infections. Of the 620 
      clinical events recorded, 41 (6.6%) were classified as IRIS on the basis of CD1, 
      and 156 (25.2%) were classified as IRIS on the basis of CD2. Positive agreement 
      between CD1 and expert opinion was low for both unmasking (17.2%; kappa = 0.24) 
      and paradoxical events (37.3%; kappa = 0.43), mainly because 1 major criterion 
      requires IRIS to be atypical and either an opportunistic infection or a tumor, 
      although negative agreement was >98%. In contrast, CD2 had good positive 
      agreement (>75% for most event types), with a kappa value of 0.75 for paradoxical 
      and 0.62 for unmasking. CONCLUSIONS: CD2 agreed well with expert opinion, with 
      additional clinical events, such as arthropathy and inflammatory dermatoses, 
      being classified as IRIS and added to CD2. We propose revised case definitions 
      for both paradoxical and unmasking IRIS.
FAU - Haddow, Lewis J
AU  - Haddow LJ
AD  - Department of HIV and Genitourinary Medicine, King's College London, London, UK.
FAU - Easterbrook, Philippa J
AU  - Easterbrook PJ
FAU - Mosam, Anisa
AU  - Mosam A
FAU - Khanyile, Nonhlanhla G
AU  - Khanyile NG
FAU - Parboosing, Raveen
AU  - Parboosing R
FAU - Moodley, Pravikrishnen
AU  - Moodley P
FAU - Moosa, Mahomed-Yunus S
AU  - Moosa MY
LA  - eng
GR  - G0200585/MRC_/Medical Research Council/United Kingdom
GR  - G0700530/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/therapeutic use
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*diagnosis/drug 
      therapy/*immunology/pathology
MH  - Male
MH  - Prospective Studies
MH  - South Africa
EDAT- 2009/10/01 06:00
MHDA- 2009/12/25 06:00
CRDT- 2009/10/01 06:00
PHST- 2009/10/01 06:00 [entrez]
PHST- 2009/10/01 06:00 [pubmed]
PHST- 2009/12/25 06:00 [medline]
AID - 10.1086/630208 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2009 Nov 1;49(9):1424-32. doi: 10.1086/630208.