PMID- 21386993
OWN - NLM
STAT- MEDLINE
DCOM- 20110901
LR  - 20211020
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 6
IP  - 2
DP  - 2011 Feb 28
TI  - Incidence and predictors of immune reconstitution inflammatory syndrome in a 
      rural area of Mozambique.
PG  - e16946
LID - 10.1371/journal.pone.0016946 [doi]
LID - e16946
AB  - BACKGROUND: There is limited data on the epidemiology of Immune Reconstitution 
      Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective 
      observational cohort study was conducted to assess the incidence, clinical 
      characteristics, outcome and predictors of IRIS in rural Mozambique. METHODS: One 
      hundred and thirty-six consecutive antiretroviral treatment (ART)-naive 
      HIV-1-infected patients initiating ART at the Manhica district hospital were 
      prospectively followed for development of IRIS over 16 months. Survival analysis 
      by Cox regression was performed to identify pre-ART predictors of IRIS 
      development. RESULTS: Thirty-six patients developed IRIS [26.5%, incidence rate 
      3.1 cases/100 persons-month of ART (95% CI 2.2-4.3)]. Median time to IRIS onset 
      was 62 days from ART initiation (IQR 35.5-93.5). Twenty-five cases (69.4%) were 
      "unmasking", 10 (27.8%) were "paradoxical", and 1 (2.8%) developed a paradoxical 
      worsening followed by the unmasking of another condition. Systemic OI (OI-IRIS) 
      accounted for 47% (17/36) of IRIS cases, predominantly of KS (8 cases) and TB (6 
      cases) IRIS. Mucocutaneous IRIS manifestations (MC-IRIS) accounted for 53% 
      (19/36) of IRIS events, mostly tinea (9 cases) and herpes simplex infection (3 
      cases). Multivariate analysis identified two independent predictors of IRIS 
      development: pre-ART CD4 count <50 cells/microl (HR 2.3, 95% CI 1.19-4.44, p = 0.01) 
      and body mass index (BMI) <18.5 (HR 2.15, 95% CI 1.07-4.3, p = 0.03). The 
      pre-cART proportion of activated T-cells, as well as the immunologic and 
      virologic response to ART were not associated with IRIS development. All patients 
      continued on ART, 7 (19.4%) required hospitalization and there were 3 deaths 
      (8.3%) attributable to IRIS. CONCLUSIONS: IRIS is common in patients initiating 
      ART in rural Mozambique. Pre-ART CD4 counts and BMI can easily be assessed at ART 
      initiation in rural sub-Saharan Africa to identify patients at high risk of IRIS, 
      for whom close supervision is warranted.
FAU - Letang, Emilio
AU  - Letang E
AD  - Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique. 
      emili.letang@cresib.cat
FAU - Miro, Jose M
AU  - Miro JM
FAU - Nhampossa, Tacilta
AU  - Nhampossa T
FAU - Ayala, Edgar
AU  - Ayala E
FAU - Gascon, Joaquim
AU  - Gascon J
FAU - Menendez, Clara
AU  - Menendez C
FAU - Alonso, Pedro L
AU  - Alonso PL
FAU - Naniche, Denise
AU  - Naniche D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110228
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*diagnosis/*epidemiology/etiology
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Mozambique/epidemiology
MH  - Prognosis
MH  - Risk Factors
MH  - Rural Population/*statistics & numerical data
MH  - Young Adult
PMC - PMC3046140
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2011/03/10 06:00
MHDA- 2011/09/02 06:00
PMCR- 2011/02/28
CRDT- 2011/03/10 06:00
PHST- 2010/12/09 00:00 [received]
PHST- 2011/01/18 00:00 [accepted]
PHST- 2011/03/10 06:00 [entrez]
PHST- 2011/03/10 06:00 [pubmed]
PHST- 2011/09/02 06:00 [medline]
PHST- 2011/02/28 00:00 [pmc-release]
AID - PONE-D-10-06328 [pii]
AID - 10.1371/journal.pone.0016946 [doi]
PST - epublish
SO  - PLoS One. 2011 Feb 28;6(2):e16946. doi: 10.1371/journal.pone.0016946.