PMID- 23152745
OWN - NLM
STAT- MEDLINE
DCOM- 20130501
LR  - 20211021
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 7
IP  - 11
DP  - 2012
TI  - Incidence, clinical spectrum, risk factors and impact of HIV-associated immune 
      reconstitution inflammatory syndrome in South Africa.
PG  - e40623
LID - 10.1371/journal.pone.0040623 [doi]
LID - e40623
AB  - BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) is a widely 
      recognised complication of antiretroviral therapy (ART), but there are still 
      limited data from resource-limited settings. Our objective was to characterize 
      the incidence, clinical spectrum, risk factors and contribution to mortality of 
      IRIS in two urban ART clinics in South Africa. METHODS AND FINDINGS: 498 adults 
      initiating ART in Durban, South Africa were followed prospectively for 24 weeks. 
      IRIS diagnosis was based on consensus expert opinion, and classified by mode of 
      presentation (paradoxical worsening of known opportunistic infection [OI] or 
      unmasking of subclinical disease). 114 patients (22.9%) developed IRIS (36% 
      paradoxical, 64% unmasking). Mucocutaneous conditions accounted for 68% of IRIS 
      events, mainly folliculitis, warts, genital ulcers and herpes zoster. 
      Tuberculosis (TB) accounted for 25% of IRIS events. 18/135 (13.3%) patients with 
      major pre-ART OIs (e.g. TB, cryptococcosis) developed paradoxical IRIS related to 
      the same OI. Risk factors for this type of IRIS were baseline viral load >5.5 vs. 
      <4.5 log(10) (adjusted hazard ratio 7.23; 95% confidence interval 1.35-38.76) and 
      </=30 vs. >30 days of OI treatment prior to ART (2.66; 1.16-6.09). Unmasking IRIS 
      related to major OIs occurred in 25/498 patients (5.0%), and risk factors for 
      this type of IRIS were baseline C-reactive protein >/=25 vs. <25 mg/L (2.77; 
      1.31-5.85), haemoglobin <10 vs. >12 g/dL (3.36; 1.32-8.52), >/=10% vs. <10% weight 
      loss prior to ART (2.31; 1.05-5.11) and mediastinal lymphadenopathy on pre-ART 
      chest x-ray (9.15; 4.10-20.42). IRIS accounted for 6/25 (24%) deaths, 13/65 (20%) 
      hospitalizations and 10/35 (29%) ART interruptions or discontinuations. 
      CONCLUSION: IRIS occurred in almost one quarter of patients initiating ART, and 
      accounted for one quarter of deaths in the first 6 months. Priority strategies to 
      reduce IRIS-associated morbidity and mortality in ART programmes include earlier 
      ART initiation before onset of advanced immunodeficiency, improved pre-ART 
      screening for TB and cryptococcal infection, optimization of OI therapy prior to 
      ART initiation, more intensive clinical monitoring in initial weeks of ART, and 
      education of health care workers and patients about IRIS.
FAU - Haddow, Lewis John
AU  - Haddow LJ
AD  - Centre for Sexual Health and HIV Research, Research Department of Infection and 
      Population Health, University College London, London, United Kingdom.
FAU - Moosa, Mahomed-Yunus Suleman
AU  - Moosa MY
FAU - Mosam, Anisa
AU  - Mosam A
FAU - Moodley, Pravi
AU  - Moodley P
FAU - Parboosing, Raveen
AU  - Parboosing R
FAU - Easterbrook, Philippa Jane
AU  - Easterbrook PJ
LA  - eng
GR  - G0700530/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20121112
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - AIDS-Related Opportunistic Infections
MH  - Adult
MH  - Antiretroviral Therapy, Highly Active/adverse effects
MH  - CD4 Lymphocyte Count
MH  - Female
MH  - Follow-Up Studies
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*epidemiology/*etiology/mortality
MH  - Incidence
MH  - Male
MH  - Risk Factors
MH  - South Africa/epidemiology
MH  - Viral Load
PMC - PMC3495974
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2012/11/16 06:00
MHDA- 2013/05/02 06:00
PMCR- 2012/11/12
CRDT- 2012/11/16 06:00
PHST- 2012/03/12 00:00 [received]
PHST- 2012/10/03 00:00 [accepted]
PHST- 2012/11/16 06:00 [entrez]
PHST- 2012/11/16 06:00 [pubmed]
PHST- 2013/05/02 06:00 [medline]
PHST- 2012/11/12 00:00 [pmc-release]
AID - PONE-D-12-07335 [pii]
AID - 10.1371/journal.pone.0040623 [doi]
PST - ppublish
SO  - PLoS One. 2012;7(11):e40623. doi: 10.1371/journal.pone.0040623. Epub 2012 Nov 12.