Incidence and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique
There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique. One hundred and t...
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| Veröffentlicht in: | PloS one 2011-02, Vol.6 (2), p.e16946-e16946 |
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| description | There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique.
One hundred and thirty-six consecutive antiretroviral treatment (ART)-naïve HIV-1-infected patients initiating ART at the Manhiça district hospital were prospectively followed for development of IRIS over 16 months. Survival analysis by Cox regression was performed to identify pre-ART predictors of IRIS development.
Thirty-six patients developed IRIS [26.5%, incidence rate 3.1 cases/100 persons-month of ART (95% CI 2.2-4.3)]. Median time to IRIS onset was 62 days from ART initiation (IQR 35.5-93.5). Twenty-five cases (69.4%) were "unmasking", 10 (27.8%) were "paradoxical", and 1 (2.8%) developed a paradoxical worsening followed by the unmasking of another condition. Systemic OI (OI-IRIS) accounted for 47% (17/36) of IRIS cases, predominantly of KS (8 cases) and TB (6 cases) IRIS. Mucocutaneous IRIS manifestations (MC-IRIS) accounted for 53% (19/36) of IRIS events, mostly tinea (9 cases) and herpes simplex infection (3 cases). Multivariate analysis identified two independent predictors of IRIS development: pre-ART CD4 count |
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One hundred and thirty-six consecutive antiretroviral treatment (ART)-naïve HIV-1-infected patients initiating ART at the Manhiça district hospital were prospectively followed for development of IRIS over 16 months. Survival analysis by Cox regression was performed to identify pre-ART predictors of IRIS development.
Thirty-six patients developed IRIS [26.5%, incidence rate 3.1 cases/100 persons-month of ART (95% CI 2.2-4.3)]. Median time to IRIS onset was 62 days from ART initiation (IQR 35.5-93.5). Twenty-five cases (69.4%) were "unmasking", 10 (27.8%) were "paradoxical", and 1 (2.8%) developed a paradoxical worsening followed by the unmasking of another condition. Systemic OI (OI-IRIS) accounted for 47% (17/36) of IRIS cases, predominantly of KS (8 cases) and TB (6 cases) IRIS. Mucocutaneous IRIS manifestations (MC-IRIS) accounted for 53% (19/36) of IRIS events, mostly tinea (9 cases) and herpes simplex infection (3 cases). Multivariate analysis identified two independent predictors of IRIS development: pre-ART CD4 count <50 cells/µl (HR 2.3, 95% CI 1.19-4.44, p = 0.01) and body mass index (BMI) <18.5 (HR 2.15, 95% CI 1.07-4.3, p = 0.03). The pre-cART proportion of activated T-cells, as well as the immunologic and virologic response to ART were not associated with IRIS development. All patients continued on ART, 7 (19.4%) required hospitalization and there were 3 deaths (8.3%) attributable to IRIS.
IRIS is common in patients initiating ART in rural Mozambique. Pre-ART CD4 counts and BMI can easily be assessed at ART initiation in rural sub-Saharan Africa to identify patients at high risk of IRIS, for whom close supervision is warranted.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0016946</identifier><identifier>PMID: 21386993</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; AIDS ; Analysis ; Antiretroviral agents ; Antiretroviral drugs ; Antiretrovirals ; Biology ; Body mass ; Body mass index ; Body size ; Care and treatment ; CD4 antigen ; Cohort Studies ; Development and progression ; Epidemiologia ; Epidemiology ; Female ; Health aspects ; Herpes simplex ; Highly active antiretroviral therapy ; HIV ; Human immunodeficiency virus ; Humans ; Immune reconstitution ; Immune Reconstitution Inflammatory Syndrome - diagnosis ; Immune Reconstitution Inflammatory Syndrome - epidemiology ; Immune Reconstitution Inflammatory Syndrome - etiology ; Incidence ; Inflammation ; Lymphocytes T ; Male ; Medical research ; Medicine ; Middle Aged ; Mozambique ; Mozambique - epidemiology ; Moçambic ; Multivariate analysis ; Patients ; Prognosis ; Regression analysis ; Risk Factors ; Rural areas ; Rural Population - statistics & numerical data ; T cells ; Tinea ; Tuberculosis ; Young Adult</subject><ispartof>PloS one, 2011-02, Vol.6 (2), p.e16946-e16946</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Letang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>cc-by (c) Letang, Emilio et al., 2011 info:eu-repo/semantics/openAccess <a href="http://creativecommons.org/licenses/by/3.0/es">http://creativecommons.org/licenses/by/3.0/es</a></rights><rights>Letang et al. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c733t-9d9e6440ad430087d1e58f6a3e249e595e5458ff6e76c8916861389fed265093</citedby><cites>FETCH-LOGICAL-c733t-9d9e6440ad430087d1e58f6a3e249e595e5458ff6e76c8916861389fed265093</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046140/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046140/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,26951,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21386993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Letang, Emilio</creatorcontrib><creatorcontrib>Miró, José M</creatorcontrib><creatorcontrib>Nhampossa, Tacilta</creatorcontrib><creatorcontrib>Ayala, Edgar</creatorcontrib><creatorcontrib>Gascon, Joaquim</creatorcontrib><creatorcontrib>Menéndez, Clara</creatorcontrib><creatorcontrib>Alonso, Pedro L</creatorcontrib><creatorcontrib>Naniche, Denise</creatorcontrib><title>Incidence and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique.
One hundred and thirty-six consecutive antiretroviral treatment (ART)-naïve HIV-1-infected patients initiating ART at the Manhiça district hospital were prospectively followed for development of IRIS over 16 months. Survival analysis by Cox regression was performed to identify pre-ART predictors of IRIS development.
Thirty-six patients developed IRIS [26.5%, incidence rate 3.1 cases/100 persons-month of ART (95% CI 2.2-4.3)]. Median time to IRIS onset was 62 days from ART initiation (IQR 35.5-93.5). Twenty-five cases (69.4%) were "unmasking", 10 (27.8%) were "paradoxical", and 1 (2.8%) developed a paradoxical worsening followed by the unmasking of another condition. Systemic OI (OI-IRIS) accounted for 47% (17/36) of IRIS cases, predominantly of KS (8 cases) and TB (6 cases) IRIS. Mucocutaneous IRIS manifestations (MC-IRIS) accounted for 53% (19/36) of IRIS events, mostly tinea (9 cases) and herpes simplex infection (3 cases). Multivariate analysis identified two independent predictors of IRIS development: pre-ART CD4 count <50 cells/µl (HR 2.3, 95% CI 1.19-4.44, p = 0.01) and body mass index (BMI) <18.5 (HR 2.15, 95% CI 1.07-4.3, p = 0.03). The pre-cART proportion of activated T-cells, as well as the immunologic and virologic response to ART were not associated with IRIS development. All patients continued on ART, 7 (19.4%) required hospitalization and there were 3 deaths (8.3%) attributable to IRIS.
IRIS is common in patients initiating ART in rural Mozambique. Pre-ART CD4 counts and BMI can easily be assessed at ART initiation in rural sub-Saharan Africa to identify patients at high risk of IRIS, for whom close supervision is warranted.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>AIDS</subject><subject>Analysis</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretrovirals</subject><subject>Biology</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Care and treatment</subject><subject>CD4 antigen</subject><subject>Cohort Studies</subject><subject>Development and progression</subject><subject>Epidemiologia</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health aspects</subject><subject>Herpes simplex</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immune reconstitution</subject><subject>Immune Reconstitution Inflammatory Syndrome - diagnosis</subject><subject>Immune Reconstitution Inflammatory Syndrome - epidemiology</subject><subject>Immune Reconstitution Inflammatory Syndrome - etiology</subject><subject>Incidence</subject><subject>Inflammation</subject><subject>Lymphocytes T</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mozambique</subject><subject>Mozambique - epidemiology</subject><subject>Moçambic</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Rural areas</subject><subject>Rural Population - statistics & numerical data</subject><subject>T cells</subject><subject>Tinea</subject><subject>Tuberculosis</subject><subject>Young 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and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique</title><author>Letang, Emilio ; Miró, José M ; Nhampossa, Tacilta ; Ayala, Edgar ; Gascon, Joaquim ; Menéndez, Clara ; Alonso, Pedro L ; Naniche, Denise</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c733t-9d9e6440ad430087d1e58f6a3e249e595e5458ff6e76c8916861389fed265093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>AIDS</topic><topic>Analysis</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretrovirals</topic><topic>Biology</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Care and treatment</topic><topic>CD4 antigen</topic><topic>Cohort 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Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Recercat</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Letang, Emilio</au><au>Miró, José M</au><au>Nhampossa, Tacilta</au><au>Ayala, Edgar</au><au>Gascon, Joaquim</au><au>Menéndez, Clara</au><au>Alonso, Pedro L</au><au>Naniche, Denise</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2011-02-28</date><risdate>2011</risdate><volume>6</volume><issue>2</issue><spage>e16946</spage><epage>e16946</epage><pages>e16946-e16946</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique.
One hundred and thirty-six consecutive antiretroviral treatment (ART)-naïve HIV-1-infected patients initiating ART at the Manhiça district hospital were prospectively followed for development of IRIS over 16 months. Survival analysis by Cox regression was performed to identify pre-ART predictors of IRIS development.
Thirty-six patients developed IRIS [26.5%, incidence rate 3.1 cases/100 persons-month of ART (95% CI 2.2-4.3)]. Median time to IRIS onset was 62 days from ART initiation (IQR 35.5-93.5). Twenty-five cases (69.4%) were "unmasking", 10 (27.8%) were "paradoxical", and 1 (2.8%) developed a paradoxical worsening followed by the unmasking of another condition. Systemic OI (OI-IRIS) accounted for 47% (17/36) of IRIS cases, predominantly of KS (8 cases) and TB (6 cases) IRIS. Mucocutaneous IRIS manifestations (MC-IRIS) accounted for 53% (19/36) of IRIS events, mostly tinea (9 cases) and herpes simplex infection (3 cases). Multivariate analysis identified two independent predictors of IRIS development: pre-ART CD4 count <50 cells/µl (HR 2.3, 95% CI 1.19-4.44, p = 0.01) and body mass index (BMI) <18.5 (HR 2.15, 95% CI 1.07-4.3, p = 0.03). The pre-cART proportion of activated T-cells, as well as the immunologic and virologic response to ART were not associated with IRIS development. All patients continued on ART, 7 (19.4%) required hospitalization and there were 3 deaths (8.3%) attributable to IRIS.
IRIS is common in patients initiating ART in rural Mozambique. Pre-ART CD4 counts and BMI can easily be assessed at ART initiation in rural sub-Saharan Africa to identify patients at high risk of IRIS, for whom close supervision is warranted.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>21386993</pmid><doi>10.1371/journal.pone.0016946</doi><tpages>e16946</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2011-02, Vol.6 (2), p.e16946-e16946 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1296444954 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Recercat; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Acquired immune deficiency syndrome Adolescent Adult Aged Aged, 80 and over AIDS Analysis Antiretroviral agents Antiretroviral drugs Antiretrovirals Biology Body mass Body mass index Body size Care and treatment CD4 antigen Cohort Studies Development and progression Epidemiologia Epidemiology Female Health aspects Herpes simplex Highly active antiretroviral therapy HIV Human immunodeficiency virus Humans Immune reconstitution Immune Reconstitution Inflammatory Syndrome - diagnosis Immune Reconstitution Inflammatory Syndrome - epidemiology Immune Reconstitution Inflammatory Syndrome - etiology Incidence Inflammation Lymphocytes T Male Medical research Medicine Middle Aged Mozambique Mozambique - epidemiology Moçambic Multivariate analysis Patients Prognosis Regression analysis Risk Factors Rural areas Rural Population - statistics & numerical data T cells Tinea Tuberculosis Young Adult |
| title | Incidence and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique |
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