International epidemiological Databases to Evaluate AIDS, Southern African region, Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Lancet Infect Dis. 2010 Apr;10(4):251-61. doi: 10.1016/S1473-3099(10)70026-8.
In patients with HIV-1 infection who are starting combination antiretroviral therapy (ART), the incidence of immune reconstitution inflammatory syndrome (IRIS) is not well defined. We did a meta-analysis to establish the incidence and lethality of the syndrome in patients with a range of previously diagnosed opportunistic infections, and examined the relation between occurrence and the degree of immunodeficiency. Systematic review identified 54 cohort studies of 13 103 patients starting ART, of whom 1699 developed IRIS. We calculated pooled cumulative incidences with 95% credibility intervals (CrI) by Bayesian methods and did a random-effects metaregression to analyse the relation between CD4 cell count and incidence of IRIS. In patients with previously diagnosed AIDS-defining illnesses, IRIS developed in 37.7% (95% CrI 26.6-49.4) of those with cytomegalovirus retinitis, 19.5% (6.7-44.8) of those with cryptococcal meningitis, 15.7% (9.7-24.5) of those with tuberculosis, 16.7% (2.3-50.7) of those with progressive multifocal leukoencephalopathy, and 6.4% (1.2-24.7) of those with Kaposi's sarcoma, and 12.2% (6.8-19.6) of those with herpes zoster. 16.1% (11.1-22.9) of unselected patients starting ART developed any type of IRIS. 4.5% (2.1-8.6) of patients with any type of IRIS died, 3.2% (0.7-9.2) of those with tuberculosis-associated IRIS died, and 20.8% (5.0-52.7) of those with cryptococcal meningitis died. Metaregression analyses showed that the risk of IRIS is associated with CD4 cell count at the start of ART, with a high risk in patients with fewer than 50 cells per microL. Occurrence of IRIS might therefore be reduced by initiation of ART before immunodeficiency becomes advanced.
在开始联合抗逆转录病毒治疗 (ART) 的 HIV-1 感染患者中，免疫重建炎症综合征 (IRIS) 的发生率尚不清楚。我们进行了一项荟萃分析，以确定一系列先前诊断的机会性感染患者中综合征的发生率和致死率，并研究了其发生与免疫缺陷程度之间的关系。系统评价确定了 54 项涉及 13103 名开始接受 ART 的患者的队列研究，其中 1699 名发生了 IRIS。我们使用贝叶斯方法计算了累积发生率的合并概率和 95%可信度区间（CrI），并进行了随机效应荟萃回归分析，以分析 CD4 细胞计数与 IRIS 发生率之间的关系。在先前诊断为艾滋病定义性疾病的患者中，发生 IRIS 的比例分别为巨细胞病毒视网膜炎患者 37.7%（95%CrI 26.6-49.4）、隐球菌性脑膜炎患者 19.5%（6.7-44.8）、结核病患者 15.7%（9.7-24.5）、进行性多灶性白质脑病患者 16.7%（2.3-50.7）、卡波西肉瘤患者 6.4%（1.2-24.7）和带状疱疹患者 12.2%（6.8-19.6）。在开始接受 ART 的未选择患者中，16.1%（11.1-22.9）发生了任何类型的 IRIS。任何类型的 IRIS 患者中有 4.5%（2.1-8.6）死亡，结核病相关 IRIS 患者中有 3.2%（0.7-9.2）死亡，隐球菌性脑膜炎患者中有 20.8%（5.0-52.7）死亡。荟萃回归分析表明，IRIS 的风险与 ART 开始时的 CD4 细胞计数相关，CD4 细胞计数低于 50 个/μL 的患者风险较高。因此，在免疫缺陷加重之前开始 ART 可能会降低 IRIS 的发生风险。
