PMID- 20334848
OWN - NLM
STAT- MEDLINE
DCOM- 20100423
LR  - 20240321
IS  - 1474-4457 (Electronic)
IS  - 1473-3099 (Print)
IS  - 1473-3099 (Linking)
VI  - 10
IP  - 4
DP  - 2010 Apr
TI  - Immune reconstitution inflammatory syndrome in patients starting antiretroviral 
      therapy for HIV infection: a systematic review and meta-analysis.
PG  - 251-61
LID - 10.1016/S1473-3099(10)70026-8 [doi]
AB  - In patients with HIV-1 infection who are starting combination antiretroviral 
      therapy (ART), the incidence of immune reconstitution inflammatory syndrome 
      (IRIS) is not well defined. We did a meta-analysis to establish the incidence and 
      lethality of the syndrome in patients with a range of previously diagnosed 
      opportunistic infections, and examined the relation between occurrence and the 
      degree of immunodeficiency. Systematic review identified 54 cohort studies of 13 
      103 patients starting ART, of whom 1699 developed IRIS. We calculated pooled 
      cumulative incidences with 95% credibility intervals (CrI) by Bayesian methods 
      and did a random-effects metaregression to analyse the relation between CD4 cell 
      count and incidence of IRIS. In patients with previously diagnosed AIDS-defining 
      illnesses, IRIS developed in 37.7% (95% CrI 26.6-49.4) of those with 
      cytomegalovirus retinitis, 19.5% (6.7-44.8) of those with cryptococcal 
      meningitis, 15.7% (9.7-24.5) of those with tuberculosis, 16.7% (2.3-50.7) of 
      those with progressive multifocal leukoencephalopathy, and 6.4% (1.2-24.7) of 
      those with Kaposi's sarcoma, and 12.2% (6.8-19.6) of those with herpes zoster. 
      16.1% (11.1-22.9) of unselected patients starting ART developed any type of IRIS. 
      4.5% (2.1-8.6) of patients with any type of IRIS died, 3.2% (0.7-9.2) of those 
      with tuberculosis-associated IRIS died, and 20.8% (5.0-52.7) of those with 
      cryptococcal meningitis died. Metaregression analyses showed that the risk of 
      IRIS is associated with CD4 cell count at the start of ART, with a high risk in 
      patients with fewer than 50 cells per microL. Occurrence of IRIS might therefore 
      be reduced by initiation of ART before immunodeficiency becomes advanced.
CI  - 2010 Elsevier Ltd. All rights reserved.
FAU - Muller, Monika
AU  - Muller M
AD  - International epidemiological Databases to Evaluate AIDS, Southern African 
      region, Institute of Social and Preventive Medicine, University of Bern, 
      Switzerland.
FAU - Wandel, Simon
AU  - Wandel S
FAU - Colebunders, Robert
AU  - Colebunders R
FAU - Attia, Suzanna
AU  - Attia S
FAU - Furrer, Hansjakob
AU  - Furrer H
FAU - Egger, Matthias
AU  - Egger M
CN  - IeDEA Southern and Central Africa
LA  - eng
GR  - U01 AI069924/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Lancet Infect Dis
JT  - The Lancet. Infectious diseases
JID - 101130150
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
CIN - Lancet Infect Dis. 2010 Dec;10(12):833-4. PMID: 21109173
MH  - Anti-HIV Agents/adverse effects/*therapeutic use
MH  - Anti-Retroviral Agents/adverse effects/*therapeutic use
MH  - HIV Infections/*drug therapy/immunology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/chemically induced/*epidemiology
MH  - Probability
MH  - Regression Analysis
PMC - PMC4183458
MID - NIHMS512436
COIS- Conflict of interest All authors declare that they have no conflicts of interest.
EDAT- 2010/03/26 06:00
MHDA- 2010/04/24 06:00
PMCR- 2014/10/02
CRDT- 2010/03/26 06:00
PHST- 2010/03/26 06:00 [entrez]
PHST- 2010/03/26 06:00 [pubmed]
PHST- 2010/04/24 06:00 [medline]
PHST- 2014/10/02 00:00 [pmc-release]
AID - S1473-3099(10)70026-8 [pii]
AID - 10.1016/S1473-3099(10)70026-8 [doi]
PST - ppublish
SO  - Lancet Infect Dis. 2010 Apr;10(4):251-61. doi: 10.1016/S1473-3099(10)70026-8.