Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy

Shelburne, Samuel Aa; Visnegarwala, Fehmidaa; Darcourt, Jorgec; Graviss, Edward Ab; Giordano, Thomas Pa; White, A Clinton Jra; Hamill, Richard Ja,d

Clinical Science

Background: There is little systematic information regarding the immune reconstitution inflammatory syndrome (IRIS).

Objective: To determine the incidence, risk factors, and long-term outcome of IRIS in HIV-infected patients receiving highly active antiretroviral therapy (HAART) who were coinfected with one of three common opportunistic pathogens.

Design: A retrospective cohort identified through a city-wide prospective surveillance program.

Methods: A retrospective chart review was performed for 180 HIV-infected patients who received HAART and were coinfected with Mycobacterium tuberculosis, Mycobacterium avium complex, or Cryptococcus neoformans between 1997 and 2000. Medical records were reviewed for baseline demographics, receipt and type of HAART, response to antiretroviral therapy, development of IRIS, and long-term outcome.

Results: In this cohort, 31.7% of patients who received HAART developed IRIS. Patients with IRIS were more likely to have initiated HAART nearer to the time of diagnosis of their opportunistic infection (P < 0.001), to have been antiretroviral naive at time of diagnosis of their opportunistic infection (P < 0.001), and to have a more rapid initial fall in HIV-1 RNA level in response to HAART (P < 0.001).

Conclusions: IRIS is common among HIV-infected persons coinfected with M. tuberculosis, M. avium complex, or C. neoformans. Antiretroviral drug-naive patients who start HAART in close proximity to the diagnosis of an opportunistic infection and have a rapid decline in HIV-1 RNA level should be monitored for development of this disorder.

From the aDepartment of Medicine, Section of Infectious Diseases

bDepartment of Medicine, Section of Infectious Diseases, University of Texas Health Science Center at Houston, Texas, USA

cDepartment of Pathology, Baylor College of Medicine, Houston

dMichael E. De Bakey VA Medical Center, Houston, Texas, USA

Received 16 July, 2004

Revised 14 October, 2004

Accepted 17 November, 2004

Correspondence to Dr R. J. Hamill, Section of Infectious Diseases (111G), Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, Texas 77030–4211, USA. E-mail: richard.hamill@med.va.gov

© 2005 Lippincott Williams & Wilkins, Inc.