Klotz Stephen A, Aziz Mohammed Abdul, Girmai Woldemichael Mulugeta, Worku Mitku Mongistu, Handrich Mitchell
Section of Infectious Diseases, School of Health Sciences, University of Arizona, Tucson, Arizona 85724, USA.
J Int Assoc Physicians AIDS Care (Chic). 2009 Mar-Apr;8(2):122-7. doi: 10.1177/1545109709332469. Epub 2009 Mar 3.
The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm(3). Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.
在埃塞俄比亚农村地区感染艾滋病毒的患者中，对与高效抗逆转录病毒疗法（HAART）相关的免疫重建炎症综合征（IRIS）进行了研究。对一家门诊诊所的1002份病历进行了回顾。CD4细胞计数的中位数为89个细胞/mm³。98名患者在开始HAART后住院，其中74名因IRIS表现而住院（即接受HAART治疗患者的7%）。在74名因IRIS住院的患者中，27名患有结核病；12名患有隐球菌性脑膜炎；7名患有弓形虫病；6名患有肺炎和/或胸腔积液；5名患有耶氏肺孢子菌肺炎（PCP）。10名成年患者因肠胃炎入院，此前未被视为IRIS的一种表现。81%的IRIS患者在开始HAART后的3个月内住院，6个月时为99%。在因IRIS住院的患者中，4名（5%）在住院期间死亡（3名患有隐球菌性脑膜炎）。因IRIS住院的患者中有37名（50%）失去了医疗随访，因此死亡率可能严重低估了IRIS的严重程度。在资源匮乏地区，主要目标是启动HAART，IRIS可能未被识别并产生致命后果。
