Department of Medicine, Feinberg School of Medicine, Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois 60611, USA.
Clin Infect Dis. 2012 Feb 1;54(3):424-33. doi: 10.1093/cid/cir802. Epub 2011 Nov 17.
The incidence of immune reconstitution inflammatory syndrome (IRIS) when antiretroviral therapy (ART) is initiated after an AIDS-defining opportunistic infection (OI) is uncertain and understudied for the most common OIs.
We examined patients in the University of Washington Human Immunodeficiency Virus Cohort initiating potent ART subsequent to an AIDS-defining OI. IRIS was determined through retrospective medical record review and adjudication using a standardized data collection process and clinical case definition. We compared demographic and clinical characteristics, and immunologic changes in patients with and without IRIS.
Among 196 patients with 260 OIs, 21 (11%; 95% confidence interval, 7%-16%) developed paradoxical IRIS in the first year on ART. The 3 most common OIs among study patients were Pneumocystis pneumonia (PCP, 28%), Candida esophagitis (23%), and Kaposi sarcoma (KS, 16%). Cumulative 1-year incidence of IRIS was 29% (12/41) for KS, 16% (4/25) for tuberculosis, 14% (1/7) for Cryptococcus, 10% (1/10) for Mycobacterium avium complex, and 4% (3/72) for PCP. Morbidity and mortality were highest in those with visceral KS-IRIS compared with other types of IRIS (100% [6/6] vs 7% [1/15], P < .01). Patients with mucocutaneous KS and tuberculosis-IRIS experienced greater median increase in CD4(+) cell count during the first 6 months of ART compared with those without IRIS (+158 vs +53 cells/μL, P = .04, mucocutaneous KS; +261 vs +113, P = .04, tuberculosis).
Cumulative incidence and features of IRIS varied depending on the OI. IRIS occurred in >10% of patients with KS, tuberculosis, or Cryptococcus. Visceral KS-IRIS led to considerable morbidity and mortality.
在发生艾滋病定义性机会性感染（OI）后开始抗逆转录病毒治疗（ART）时，免疫重建炎症综合征（IRIS）的发生率尚不确定，且针对最常见的 OI 研究甚少。
我们对在发生艾滋病定义性 OI 后开始使用强效 ART 的华盛顿大学人类免疫缺陷病毒队列中的患者进行了研究。通过回顾性病历审查和使用标准化数据收集过程和临床病例定义进行的裁决来确定 IRIS。我们比较了有和无 IRIS 患者的人口统计学和临床特征以及免疫变化。
在 196 例患有 260 例 OI 的患者中，有 21 例（11%；95%置信区间，7%-16%）在开始 ART 的第一年出现了矛盾性 IRIS。研究患者中最常见的 3 种 OI 是卡氏肺孢子菌肺炎（PCP，28%）、念珠菌食管炎（23%）和卡波西肉瘤（KS，16%）。KS 的累积 1 年 IRIS 发生率为 29%（12/41），结核为 16%（4/25），隐球菌为 14%（1/7），鸟分枝杆菌复合群为 10%（1/10），PCP 为 4%（3/72）。与其他类型的 IRIS 相比，内脏 KS-IRIS 患者的发病率和死亡率最高（100%[6/6] vs 7%[1/15]，P<.01）。黏膜 KS 和结核 IRIS 患者在开始 ART 的前 6 个月内 CD4+细胞计数中位数增加幅度更大，与无 IRIS 患者相比分别为（+158 vs +53 个/μL，P=.04，黏膜 KS；+261 vs +113，P=.04，结核）。
IRIS 的累积发生率和特征取决于 OI。KS、结核或隐球菌患者的 IRIS 发生率超过 10%。内脏 KS-IRIS 导致相当高的发病率和死亡率。
