Impact of the immune reconstitution inflammatory syndrome (IRIS) on mortality and morbidity in HIV-infected patients in Mexico

Hoyo-Ulloa, Irma; Belaunzarán-Zamudio, Pablo F.; Crabtree-Ramírez, Brenda; Pérez-Aguinaga, María Eugenia; Sierra‐Madero, Juan

doi:10.1016/j.ijid.2011.02.007

Cited by 32 publications

(32 citation statements)

References 30 publications

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“…Retrospective studies from Mexico (22) and Mozambique (23) of 390 and 136 patients respectively initiating ART indicate that the incidence of IRIS is approximately 27%. The vast majority of IRIS cases are associated with opportunistic infections (OI) either recognized prior to initiation of ART but worsening after therapy (paradoxical IRIS) or recognized after therapy initiation due to the restoration of the immune system (unmasking IRIS) (Figure 1).…”

Section: Incidence Of Iris and Cns-irismentioning

confidence: 99%

“…IRIS is associated with an increased risk of mortality (mortality ratio of 2.3) and hospitalization (three fold risk) after adjusting for confounding factors (22). Similar trends in mortality were found in another adult (23) and a pediatric cohort (30*).…”

Section: Iris: Mortality and Risk Factorsmentioning

confidence: 99%

“…While CNS-IRIS is a smaller proportion of all IRIS cases, it represents the most debilitating form of IRIS and is associated with death or permanent neurological deficit in an estimated 16-50% of cases (27, 29**, 31, 32). The CD4 nadir, an indicator of the degree of immune suppression, and the presence of an OI at the time of initiation of ART are the greatest risk factors for the development of IRIS (3, 22, 33). A reduced body mass index was also independently associated with the development of IRIS in two separate cohorts; however occurrence of CNS-IRIS was not included in the analysis (22, 23).…”

Section: Iris: Mortality and Risk Factorsmentioning

confidence: 99%

“…The CD4 nadir, an indicator of the degree of immune suppression, and the presence of an OI at the time of initiation of ART are the greatest risk factors for the development of IRIS (3, 22, 33). A reduced body mass index was also independently associated with the development of IRIS in two separate cohorts; however occurrence of CNS-IRIS was not included in the analysis (22, 23). …”

Section: Iris: Mortality and Risk Factorsmentioning

confidence: 99%

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New insights into immune reconstitution inflammatory syndrome of the central nervous system

Johnson

Nath

2014

Current Opinion in HIV and AIDS

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Purpose of review To highlight the importance of immune reconstitution inflammatory syndrome (IRIS) affecting the brain in HIV-infected individuals in the absence of opportunistic infections. To describe the varied clinical manifestations, unifying pathophysiological features and discuss the principles of management of this syndrome. Recent Findings IRIS within the brain is commonly seen in patients with HIV infection upon initiation of antiretroviral drugs. The fulminant forms occur in the face of opportunistic infections or uncontrolled viral replication within the brain. In this case the enhanced immune response is targeted against the microbial agent, and the brain suffers bystander damage. Treatment requires the combination of the antimicrobial agent, continued antiretrovirals and in some cases corticosteroids. It is increasingly being recognized that despite adequate control of viral replication in the brain some patients develop a chronic form of T cell encephalitis which appears to be driven by continued production of HIV-Tat protein. In others the immune response may be targeted against the host antigens in the brain. Summary In patients with CNS-IRIS the use of corticosteroids and strategies that prevent T cell migration into the brain may be needed. Extreme caution is necessary if viral eradication strategies are to employed that involve activation of viral reservoirs, since these patients may be at risk for developing CNS-IRIS.

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Section: Incidence Of Iris and Cns-irismentioning

confidence: 99%

Section: Iris: Mortality and Risk Factorsmentioning

confidence: 99%

Section: Iris: Mortality and Risk Factorsmentioning

confidence: 99%

Section: Iris: Mortality and Risk Factorsmentioning

confidence: 99%

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New insights into immune reconstitution inflammatory syndrome of the central nervous system

Johnson

Nath

2014

Current Opinion in HIV and AIDS

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“…2 IRIS has been associated with increased hospitalizations, longer hospitalizations, and death. 3,4 The major risks for IRIS are low CD4 cells, 5,6 high plasma HIV RNA levels, OIs when starting ART, 3,5,6 and a short time between ART start and treatment initiation for OIs. 6 …”

Section: Introductionmentioning

confidence: 99%

Effect of the CCR5 antagonist maraviroc on the occurrence of immune reconstitution inflammatory syndrome in HIV (CADIRIS): a double-blind, randomised, placebo-controlled trial

et al. 2014

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Background Immune Reconstitution Inflammatory Syndrome (IRIS) is a common complication of antiretroviral therapy (ART) in HIV-infected patients. IRIS is associated with an increased risk of hospitalization and death. We ascertained whether CCR5 blockade using maraviroc reduces the risk of IRIS. Methods The CADIRIS study was a randomized, double-blind, placebo-controlled, clinical trial that accrued subjects from five clinical sites in Mexico and one in South Africa between November 2009 and January 2012, and followed them for one year. The primary outcome was occurrence of IRIS by 24 weeks. HIV-infected adults, naïve to ART, with CD4 cells <100/μL, and HIVRNA >1,000 copies/mL were eligible. We screened 362 subjects; 279 met inclusion criteria, 3 refused participation, and 276 were randomized. Participants received maraviroc 600 mg twice daily or placebo added to an ART regimen that included tenofovir, emtricitabine, and efavirenz for 48 weeks. Findings There were 276 patients randomized (140 received maraviroc and 136 placebo). There was no difference in the time to IRIS events between treatment arms (HR 1·08, 95% CI (0·66, 1·77), log-rank test p=0·743). In total, 64 (23%) patients had IRIS events, 33 (24%) in the maraviroc arm and 31 (23%) in the placebo arm (p=0·88). Interpretation Maraviroc had no significant effect on frequency, time or severity of IRIS events after ART initiation. Including a CCR5 inhibitor in an initial treatment regimen does not confer a meaningful protection from the occurrence of IRIS in persons with advanced HIV infection. Funding The trial was funded as investigator initiated research by Pfizer Inc, New York, NY, USA. Trial Registration ClinicalTrials.gov. ID: NCT00988780 (http://clinicaltrials.gov/ct2/show/NCT00988780)

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Syndrome de restauration immunitaire chez les patients infectés par le virus de l’immunodéficience humaine et traités par antirétroviraux

2013

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Impact of the immune reconstitution inflammatory syndrome (IRIS) on mortality and morbidity in HIV-infected patients in Mexico

Cited by 32 publications

References 30 publications

New insights into immune reconstitution inflammatory syndrome of the central nervous system

New insights into immune reconstitution inflammatory syndrome of the central nervous system

Effect of the CCR5 antagonist maraviroc on the occurrence of immune reconstitution inflammatory syndrome in HIV (CADIRIS): a double-blind, randomised, placebo-controlled trial

Syndrome de restauration immunitaire chez les patients infectés par le virus de l’immunodéficience humaine et traités par antirétroviraux

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