Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, Mozambique.
J Acquir Immune Defic Syndr. 2010 Apr;53(5):589-97. doi: 10.1097/QAI.0b013e3181bc476f.
The impact and relevance of immune reconstitution inflammatory syndrome-associated with Kaposi sarcoma (IRIS-KS) has not been assessed in sub-Saharan African countries, where the bulk of HIV-1 and KS-associated herpesvirus (KSHV) coinfection occurs. Understanding the risk factors for developing IRIS-KS would aid in the identification and in the improvement of clinical management for high-risk patients.
Sixty-nine consecutive HIV-1 and KSHV coinfected Mozambican adults initiating cART were prospectively followed for development of IRIS-KS over 10 months as part of a larger prospective observational study. Plasma HIV RNA, CD4 counts, anti-KSHV lytic antibodies, and plasma KSHV DNA viral load were assessed at the pre-cART visit and at 4 and 10 months after cART initiation. A survival analysis was performed to assess potential risk factors for developing IRIS-KS.
During the first 10 months of combined antiretroviral therapy (cART), 8 patients (8/69, 11.6%) experienced IRIS-KS at a median time of 13.8 weeks after cART initiation. Multivariate analysis identified 4 independent IRIS-KS predictors: clinical pretreatment KS [hazard ratio (HR) 91.7], detectable plasma KSHV DNA (HR 24.4), hematocrit <30% (HR 26.5), and plasma HIV-1 RNA viral load (HR 34.6 per log viral load increase). Treatment with either cART alone or with a combination of cART and systemic chemotherapy led to partial or complete clinical response in 62.5% (5/8) of IRIS-KS cases.
This study identified 4 independent predictors of IRIS-KS, which may help to develop screening tools aiding in the identification of patients at high risk of IRIS-KS for whom close clinical supervision is warranted.
在撒哈拉以南非洲国家，艾滋病毒 1 型（HIV-1）和卡波西肉瘤相关疱疹病毒（KSHV）合并感染的情况最为常见，但尚未评估与卡波西肉瘤相关的免疫重建炎症综合征（IRIS-KS）的影响和相关性。了解发生 IRIS-KS 的危险因素有助于确定和改善高危患者的临床管理。
作为一项更大的前瞻性观察性研究的一部分，69 例连续的 HIV-1 和 KSHV 合并感染的莫桑比克成年人在开始接受 cART 的过程中前瞻性地随访了 10 个月，以确定是否发生 IRIS-KS。在 cART 前、cART 开始后 4 个月和 10 个月时评估血浆 HIV RNA、CD4 计数、抗 KSHV 裂解抗体和血浆 KSHV DNA 病毒载量。进行生存分析以评估发生 IRIS-KS 的潜在危险因素。
在联合抗逆转录病毒治疗（cART）的前 10 个月中，8 例（8/69，11.6%）患者在 cART 开始后 13.8 周的中位时间内出现 IRIS-KS。多变量分析确定了 4 个独立的 IRIS-KS 预测因素：临床预处理期卡波西肉瘤（HR 91.7）、可检测到的血浆 KSHV DNA（HR 24.4）、血细胞比容<30%（HR 26.5）和血浆 HIV-1 RNA 病毒载量（HR 每增加 1 个对数病毒载量增加 34.6）。IRIS-KS 病例中，62.5%（5/8）用 cART 单药或 cART 联合全身化疗治疗后出现部分或完全临床缓解。
本研究确定了 4 个独立的 IRIS-KS 预测因素，这可能有助于开发筛查工具，帮助识别发生 IRIS-KS 风险较高的患者，对这些患者需要密切临床监测。
