To Avoid Immune Reconstitution Inflammatory Syndrome (IRIS), Patients Should Initiate HAART Before CD4 Count Falls Below 100 Cells

As some individuals respond to initiation of HAART, they develop opportunistic infections (OIs). This somewhat counter-intuitive development is referred to as Immune Reconstitution Inflammatory Syndrome (IRIS). In the present retrospective study, conducted in Poland, researchers determined the risk to HIV positive persons of developing IRIS.

To evaluate the occurrence of and risk factors for IRIS during HAART, the investigators examined the records of 389 patients on HAART in their clinic January 1, 1998 to May 31,2004. Baseline and follow-up values of CD4 T-cell counts and plasma viral loads (pVLs) were compared to assess the success of HAART.

Results

· During successful HAART (defined as a significant increase in CD4 T-cell counts and a decrease in pVL), at least one IRIS episode occurred in 65 patients (16.7%).

· Median time to IRIS was 4.6 months (range 2 - 12 months).

· IRIS included dermatomal herpes zoster (26 patients), pulmonary tuberculosis (four patients), tuberculous exudative pericarditis (two patients), tuberculous lymphadenitis (two patients), cerebral toxoplasmosis (one patient), progressive multifocal leucoencephalopathy (PML) (one patient), inflamed molluscum (one patient), inflamed Candida albicans angular cheilitis (three patients), genital herpes simplex (two patients), tinea corporis (two patients), cytomegalovirus (CMV) retinitis (two patients), CMV vitritis (one patient) and hepatitis B (three patients) or C (fifteen patients).

· A baseline CD4 T-cell count below 100 cells/microliter was shown to be the single predictor of IRIS, while a CD4 T-cell count increase to >400 cells/microliter, but not undetectable pVL, was a negative predictor of IRIS.

The authors conclude, “To avoid IRIS in advanced patients, HAART should be initiated before the CD4 T-cell count falls below 100 cells/microliter.”

More Articles on IRIS, also called Immune Restoration Disease (IRD)

Autoimmune Thyroid Disease Occurring as a Late Complication of Immune Reconstitution Disease in HIV Patients - 3/16/05

Toward Defining the Incidence, Risk Factors and Long-term Outcome of a Unique,  HAART-related Disease: Immune Reconstitution Inflammatory Syndrome (IRIS) - 3/11/05

Incidence of Immune Reconstitution Syndrome in HIV-Tuberculosis Coinfected Patients in India - 2/11/05

Illness of Immune Reconstitution: Recognition and Management - 2/09/05

Kaposi's Sarcoma-associated Inflammation Seen after HAART - 1/03/05

Recurrence of Pneumocystis carinii Pneumonia: Selective Immune Reconstitution after HAART - 9/20/04

HAART-Associated Syndrome Linked to Leprosy in HIV Patients - 09/13/04

Varicella Zoster Virus Is a Manifestation of Immune Restoration Disease in HIV Positive Children 04/28/04

04/04/05

Reference
D J Jevtovi and others. The prevalence and risk of immune restoration disease in HIV-infected patients treated with highly active antiretroviral therapy. HIV Medicine 6(2): 140-143. March 2005.

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