Espinosa E, Ormsby C E, Vega-Barrientos R S, Ruiz-Cruz M, Moreno-Coutiño G, Peña-Jiménez A, Peralta-Prado A B, Cantoral-Díaz M, Romero-Rodríguez D P, Reyes-Terán G
Center for Infectious Diseases Research (CIENI), Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Mexico City, Mexico.
Int J STD AIDS. 2010 Aug;21(8):573-9. doi: 10.1258/ijsa.2010.010135.
In order to discriminate general from aetiology-specific risk factors for immune reconstitution inflammatory syndrome (IRIS), we followed up, during six months, 99 patients with advanced HIV infection commencing antiretroviral therapy (ART) without active opportunistic infections or evident inflammation. IRIS predictors were determined by univariate analysis using clinical data from 76 ART-responding patients either completing follow-up or developing IRIS, and by multivariate analysis of inflammation, disease progression and nutrition status variables. We identified 23 primary IRIS events (30.3%). Univariate predictors for all IRIS events were higher platelet counts and lower CD4/CD8 ratio, whereas subclinical inflammation was the multivariate predictor. Platelets, alkaline phosphatase levels and %CD8 T-cells in univariate analysis also predicted mycobacteria-associated IRIS independently, remaining elevated during follow-up. Herpesvirus IRIS was predicted by platelets and inflammation. Indicators of advanced HIV disease and subclinical inflammation jointly predict IRIS, and some are specific of the underlying microbial aetiology, possibly explaining previous reports.
为了区分免疫重建炎症综合征（IRIS）的一般风险因素和特定病因风险因素，我们对99例开始接受抗逆转录病毒治疗（ART）且无活动性机会性感染或明显炎症的晚期HIV感染者进行了为期六个月的随访。通过对76例完成随访或发生IRIS的ART反应患者的临床数据进行单因素分析，并对炎症、疾病进展和营养状况变量进行多因素分析，确定了IRIS的预测因素。我们共识别出23例原发性IRIS事件（30.3%）。所有IRIS事件的单因素预测因素为血小板计数较高和CD4/CD8比值较低，而亚临床炎症是多因素预测因素。单因素分析中的血小板、碱性磷酸酶水平和CD8 T细胞百分比也独立预测了分枝杆菌相关的IRIS，在随访期间持续升高。血小板和炎症可预测疱疹病毒IRIS。晚期HIV疾病和亚临床炎症指标共同预测IRIS，其中一些指标是特定潜在微生物病因所特有的，这可能解释了既往报道。
