PMID- 22095568
OWN - NLM
STAT- MEDLINE
DCOM- 20120509
LR  - 20220311
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Print)
IS  - 1058-4838 (Linking)
VI  - 54
IP  - 3
DP  - 2012 Feb 1
TI  - Paradoxical immune reconstitution inflammatory syndrome in HIV-infected patients 
      treated with combination antiretroviral therapy after AIDS-defining opportunistic 
      infection.
PG  - 424-33
LID - 10.1093/cid/cir802 [doi]
AB  - 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 CD4(+) cell count during the first 6 months of ART 
      compared with those without IRIS (+158 vs +53 cells/muL, P = .04, mucocutaneous 
      KS; +261 vs +113, P = .04, tuberculosis). CONCLUSIONS: Cumulative incidence and 
      features of IRIS varied depending on the OI. IRIS occurred in >10% of patients 
      with KS, tuberculosis, or Cryptococcus. Visceral KS-IRIS led to considerable 
      morbidity and mortality.
FAU - Achenbach, Chad J
AU  - Achenbach CJ
AD  - Department of Medicine, Feinberg School of Medicine, Division of Infectious 
      Diseases and Center for Global Health, Northwestern University, Chicago, Illinois 
      60611, USA. c-achenbach@northwestern.edu
FAU - Harrington, Robert D
AU  - Harrington RD
FAU - Dhanireddy, Shireesha
AU  - Dhanireddy S
FAU - Crane, Heidi M
AU  - Crane HM
FAU - Casper, Corey
AU  - Casper C
FAU - Kitahata, Mari M
AU  - Kitahata MM
LA  - eng
GR  - P30 AI027757/AI/NIAID NIH HHS/United States
GR  - T32 AI007140/AI/NIAID NIH HHS/United States
GR  - T32 AI07140-31/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20111117
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
CIN - Clin Infect Dis. 2012 Jul;55(1):157-8; author reply 158-9. PMID: 22491336
MH  - *AIDS-Related Opportunistic Infections
MH  - Acquired Immunodeficiency Syndrome/*drug therapy
MH  - Adult
MH  - Anti-HIV Agents/administration & dosage/*adverse effects/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - CD8-Positive T-Lymphocytes
MH  - Cohort Studies
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*chemically induced
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Retrospective Studies
PMC - PMC3258272
EDAT- 2011/11/19 06:00
MHDA- 2012/05/10 06:00
PMCR- 2013/02/01
CRDT- 2011/11/19 06:00
PHST- 2011/11/19 06:00 [entrez]
PHST- 2011/11/19 06:00 [pubmed]
PHST- 2012/05/10 06:00 [medline]
PHST- 2013/02/01 00:00 [pmc-release]
AID - cir802 [pii]
AID - 10.1093/cid/cir802 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2012 Feb 1;54(3):424-33. doi: 10.1093/cid/cir802. Epub 2011 Nov 
      17.