Ratnam I, Chiu C, Kandala N-B, Easterbrook P J
Department of HIV/Genitourinary Medicine, King's College London, Guy's, King's College and St. Thomas' Hospitals, London, United Kingdom.
Clin Infect Dis. 2006 Feb 1;42(3):418-27. doi: 10.1086/499356. Epub 2005 Dec 28.
It is estimated that 10%-25% of patients who start highly active antiretroviral therapy (HAART) experience immune reconstitution inflammatory syndrome (IRIS). Our objective was to determine the incidence, clinical spectrum, and predictors of IRIS in an ethnically diverse cohort of patients initiating HAART.
A retrospective study of all patients starting HAART between 1 January 2000 and 31 August 2002 at a human immunodeficiency virus (HIV) clinic in London was performed. All laboratory measurements and data on antiretroviral therapies were obtained from the clinic database. Medical records were reviewed to identify clinical events consistent with IRIS during the 6 months after HAART was initiated.
A total of 199 patients were included, of whom 50.8% were male, 59.3% were black African, 29.1% were white, and 10.5% were black Caribbean. The median baseline CD4 cell count and HIV RNA load were 174x10(6) cells/L (interquartile range [IQR], 82-285x10(6) cells/L) and 37,830 copies/mL (IQR, 4809-149,653 copies/mL), respectively. Forty-four patients (22.7%) experienced an IRIS event at a median of 12 weeks after HAART initiation (IQR, 4-24 weeks after initiation); 22 events (50%) involved genital herpes, 10 (23%) involved genital warts, 4 (9.0%) involved molluscum contagiosum, and 4 (9.0%) involved varicella zoster virus infection. Five patients had mycobacterial infections, 4 had hepatitis B, 1 had Pneumocystis jirovecci infection, and 1 had Kaposi sarcoma. The strongest independent predictors of IRIS were younger age at initiation of HAART (P=.003), baseline CD4 cell percentage of <10% (odds ratio [OR], 2.97; IQR, 1.17-7.55) compared with >15%, and ratio of CD4 cell percentage to CD8 cell percentage of <0.15 (OR, 3.45; 95% confidence interval, 1.27-9.1) compared with >0.3.
Approximately one-quarter of patients who start HAART experience an IRIS event. The majority are dermatological, in particular genital herpes and warts. Patients with advanced immunodeficiency at HAART initiation are at greatest risk of developing IRIS and should be appropriately screened and monitored.
据估计，开始高效抗逆转录病毒治疗（HAART）的患者中有10% - 25%会经历免疫重建炎症综合征（IRIS）。我们的目的是确定在开始HAART的不同种族患者队列中IRIS的发病率、临床谱和预测因素。
对2000年1月1日至2002年8月31日期间在伦敦一家人类免疫缺陷病毒（HIV）诊所开始HAART的所有患者进行回顾性研究。所有实验室测量值和抗逆转录病毒治疗数据均从诊所数据库中获取。审查医疗记录以确定在开始HAART后的6个月内与IRIS一致的临床事件。
共纳入199例患者，其中50.8%为男性，59.3%为非洲黑人，29.1%为白人，10.5%为加勒比黑人。基线CD4细胞计数和HIV RNA载量的中位数分别为174×10⁶细胞/L（四分位间距[IQR]，82 - 285×10⁶细胞/L）和37,830拷贝/mL（IQR，4809 - 149,653拷贝/mL）。44例患者（22.7%）在开始HAART后的中位数12周时经历了IRIS事件（IQR，开始后4 - 24周）；22例事件（50%）涉及生殖器疱疹，10例（23%）涉及尖锐湿疣，4例（9.0%）涉及传染性软疣，4例（9.0%）涉及水痘带状疱疹病毒感染。5例患者有分枝杆菌感染，4例有乙型肝炎，1例有耶氏肺孢子菌感染，1例有卡波西肉瘤。IRIS最强的独立预测因素是开始HAART时年龄较小（P = 0.003），基线CD4细胞百分比<10%（比值比[OR]，2.97；IQR，1.17 - 7.55）与>15%相比，以及CD4细胞百分比与CD8细胞百分比的比值<0.15（OR，3.45；95%置信区间，1.27 - 9.1）与>0.3相比。
开始HAART的患者中约四分之一会经历IRIS事件。大多数是皮肤病学方面的，特别是生殖器疱疹和尖锐湿疣。开始HAART时免疫缺陷严重的患者发生IRIS的风险最高，应进行适当的筛查和监测。
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