PMID- 34242683
OWN - NLM
STAT- MEDLINE
DCOM- 20210916
LR  - 20210916
IS  - 1532-2742 (Electronic)
IS  - 0163-4453 (Linking)
VI  - 83
IP  - 3
DP  - 2021 Sep
TI  - Risk factors for IRIS in HIV-associated Pneumocystis-pneumonia following ART 
      initiation.
PG  - 347-353
LID - S0163-4453(21)00326-1 [pii]
LID - 10.1016/j.jinf.2021.06.027 [doi]
AB  - BACKGROUND: HIV-infected patients with Pneumocystis-pneumonia (PCP) may develop 
      paradoxical immune reconstitution inflammatory syndrome (IRIS), when combination 
      antiretroviral therapy (cART) is started early during the course of PCP-treatment 
      (PCPT). The aim of this study was to identify risk factors and predictors for 
      PCP-IRIS and to improve individualized patient care. METHODS: An ICD-10 code 
      hospital database query identified all Frankfurt HIV Cohort patients being 
      diagnosed with PCP from January 2010 - June 2016. Patient charts were evaluated 
      retrospectively for demographic, clinical and therapeutic (cART/PCPT) 
      characteristics and incidence of paradoxical IRIS according to French's case 
      definitions. RESULTS: IRIS occurred in 12/97 patients that started cART while on 
      PCPT (12.4%). They had a higher rate of re-hospitalization (41.7vs. 4.7%; odds 
      ratio (OR) 14.46; p = 0.009), intensive care treatment (66.7vs. 30.6%; OR = 4.54; 
      p = 0.018), and longer median hospitalization (48 days vs. 23; p < 0.001). A high 
      HIV-RNA level (> 6Log(10)/ml) before cART initiation was associated with IRIS 
      development (41.6vs. 15.0%; OR 4.05; p = 0.042). Serum immunoglobulin G-levels 
      (IgG) [mg/dl] were lower (894.0 vs. 1446.5; p = 0.023). CONCLUSION: Higher 
      hospitalization rate and morbidity parameters underscore the clinical importance 
      of PCP-related paradoxical IRIS. A baseline viral load of > 6Log10/ml and serum 
      IgG may help to assess individual risks for PCP-IRIS.
CI  - Copyright (c) 2021 The British Infection Association. Published by Elsevier Ltd. 
      All rights reserved.
FAU - Kann, Gerrit
AU  - Kann G
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Wetzstein, Nils
AU  - Wetzstein N
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Bielke, Hannah
AU  - Bielke H
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Schuettfort, Gundolf
AU  - Schuettfort G
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Haberl, Annette E
AU  - Haberl AE
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Wolf, Timo
AU  - Wolf T
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Kuepper-Tetzel, Claus P
AU  - Kuepper-Tetzel CP
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Wieters, Imke
AU  - Wieters I
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany.
FAU - Kessel, Johanna
AU  - Kessel J
AD  - INFEKTIOLOGIKUM, Frankfurt am Main, Germany.
FAU - de Leuw, Philipp
AU  - de Leuw P
AD  - INFEKTIOLOGIKUM, Frankfurt am Main, Germany.
FAU - Bickel, Markus
AU  - Bickel M
AD  - INFEKTIOLOGIKUM, Frankfurt am Main, Germany.
FAU - Khaykin, Pavel
AU  - Khaykin P
AD  - MAINFACHARZT, Frankfurt am Main, Germany.
FAU - Stephan, Christoph
AU  - Stephan C
AD  - Department of Internal Medicine, Infectious Diseases, University Hospital 
      Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, 
      Germany. Electronic address: christoph.stephan@kgu.de.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210707
PL  - England
TA  - J Infect
JT  - The Journal of infection
JID - 7908424
SB  - IM
MH  - *HIV Infections/complications/drug therapy
MH  - Humans
MH  - *Immune Reconstitution Inflammatory Syndrome/epidemiology
MH  - *Pneumocystis
MH  - *Pneumonia, Pneumocystis/epidemiology
MH  - Retrospective Studies
MH  - Risk Factors
OTO - NOTNLM
OT  - Acquired immunodeficiency syndrome (AIDS)
OT  - Combination antiretroviral therapy (cART)
OT  - Human immunodeficiency virus (HIV)
OT  - Immune reconstitution inflammatory syndrome (IRIS)
OT  - Pneumocystis jirovecii
OT  - Pneumocystis pneumonia (PCP)
OT  - Risk factors
COIS- Conflict of interest and funding sources This is an investigator-initiated study, 
      funded by the Frankfurt University Hospital. Important contents of this work had 
      been presented at the Conference on Retroviruses and Opportunistic Infections 
      (CROI), in Boston MA (U.S.A.), March 4-7, 2018; abstract # P-795, and at the 
      German Conference on Infectious Diseases and Tropical Medicine 2018 in Cologne, 
      Germany, June 20-23, 2018; abstract P-039. Gerrit Kann, Nils Wetzstein, Hannah 
      Bielke, Claus P. Kuepper-Tetzel, Imke Wieters, Philipp de Leuw and Markus Bickel 
      have nothing to disclose. Gundolf Schuettfort received funding from Gilead 
      Sciences and speaker fees from ViiV Healthcare, Bristol Meyer Squibb, MSD and 
      Hormosan for participation in Advisory Boards, Data Safety and Monitoring Boards 
      and for preparation of educational materials and lecturing fees, all outside the 
      submitted work. Annette E. Haberl received speaker fees from Gilead Sciences, 
      Janssen-Cilag and MSD and also participated in MSD advisory boards. Support of 
      congress participation was provided by Gilead Sciences and Janssen-Cilag. Timo 
      Wolf received fees for lectures, consultancies and travel grants from: Gilead, 
      Merck Sharp Dome, Janssen, all outside the submitted work. Johanna Kessel 
      received travel grants from Correvio outside the submitted work. Pavel Khaykin 
      received speaker honoraria and fees for scientific advice from AbbVie, Camurus, 
      Gilead Sciences, Janssen, MSD, ViiV healthcare, all outside the submitted work. 
      Christoph Stephan has received research grants from Gilead Sciences, Janssen, 
      MSD, ViiV-Healthcare and has received fees for scientific advice from Merck/MSD, 
      and Theratechnologies, all outside the submitted work.
EDAT- 2021/07/10 06:00
MHDA- 2021/09/18 06:00
CRDT- 2021/07/09 20:14
PHST- 2021/03/09 00:00 [received]
PHST- 2021/05/27 00:00 [revised]
PHST- 2021/06/30 00:00 [accepted]
PHST- 2021/07/10 06:00 [pubmed]
PHST- 2021/09/18 06:00 [medline]
PHST- 2021/07/09 20:14 [entrez]
AID - S0163-4453(21)00326-1 [pii]
AID - 10.1016/j.jinf.2021.06.027 [doi]
PST - ppublish
SO  - J Infect. 2021 Sep;83(3):347-353. doi: 10.1016/j.jinf.2021.06.027. Epub 2021 Jul 
      7.