Integrase strand transfer inhibitor treatment does not increase the incidence of immune reconstitution inflammatory syndrome in HIV‐infected Koreans

Abstract

Objectives Immune reconstitution inflammatory syndrome (IRIS) is a major concern when starting antiretroviral therapy (ART) in patients with advanced HIV infection. The aim of this study was to determine the incidence and risk factors of IRIS in HIV‐infected Koreans initiating ART, and whether integrase strand transfer inhibitor (INSTI) treatment increases the risk of IRIS. Methods This retrospective analysis included adults living with HIV, seen at four university‐affiliated hospitals in South Korea, who were naïve to ART and had a CD4 T‐cell count < 200 cells/μL between January 2004 and May 2019. IRIS was determined through a medical record review within 6 months of ART initiation. Propensity score‐matched case–control study between the non‐INSTI and INSTI groups was performed. Results The study included 501 patients; 192 were assigned to the INSTI group, who started ART based on INSTIs as the initial treatment. There were opportunistic infections (OIs) in 253 (50.5%) cases before ART initiation. The three most common OIs were Pneumocystis jirovecii pneumonia, candidiasis and tuberculosis (TB). We identified 47 cases of IRIS; TB‐IRIS was the most common type. The incidence of IRIS within 6 months of ART initiation was 9.4%, and there were no significant differences in baseline characteristics and incidence of IRIS between the matched groups. The risk factors for IRIS were pre‐ART CD4 T‐cell count (< 30 cells/μL), higher pre‐ART viral load (≥ 75 000 copies/mL), and TB‐OI. Conclusions The incidence of IRIS was 9.4% in Korean HIV patients. The INSTI regimen was not related to IRIS occurrence.

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in initiating ART among HIV-Infected patients in China-risk factors and management

“…Our study suggests that the timing of ART initiation should not be delayed due to concerns about increased TB-IRIS risk when using INSTI-based regimens. Our results are consistent with a Korean retrospective study [ 37 ] and a randomized Reduction of Early Mortality (REALITY) trial conducted in sub-Saharan African countries [ 38 ]. Notably, our study exclusively focused on TB-IRIS, excluding IRIS caused by other pathogens.…”

A retrospective clinical study of dolutegravir- versus efavirenz-based regimen in treatment-naïve patients with advanced HIV infection in Nanjing, China

“…However, in the present study, despite rapid viral suppression and greater CD4+ T-cell count increase in the DTG group, the diagnosis of IRIS did not higher than the EFV group (P=0.224). Our results were similar to those of a South Korean study conducted in patients with CD4+ T-cell count < 200 cells/mL, which also had IRIS mostly related to tuberculosis (47).…”

Letter to the editor

“…Dear Editor, Recently, Kim and colleagues published in your journal an original piece of research stating that integrase strand transfer inhibitors (INSTIs) do not increase the incidence of immune reconstitution inflammatory syndrome (IRIS) in patients living with HIV (PLHIV) [1]. They analysed a population of 501 PLHIV in Korea with a CD4 T-cell count < 200 cells/μL starting their first antiretroviral therapy (ART) regimen between January 2004 and May 2019.…”