Immune Reconstitution Inflammatory Syndrome (IRIS): Incidence, Characteristics and Predictive factors

Deepti, Gurdasani (2008) Immune Reconstitution Inflammatory Syndrome (IRIS): Incidence, Characteristics and Predictive factors. Masters thesis, Christian Medical College, Vellore.

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Abstract

OBJECTIVES OF THE STUDY : To study the incidence and predictive factors of immune reconstitution inflammatory syndrome (IRIS) among a cohort of patients initiated on HAART and describe this syndrome among them. METHODS : A cohort of patients with HIV infection initiated on HAART at Christian Medical College and Hospital and government ART centres was prospectively followed up for a minimum of six months to observe for the development of IRIS. Baseline CD4 cell counts, WHO staging of patients, BMI and presence of previous opportunistic infections were recorded in all patients. Overall incidence and opportunistic infection specific incidences of IRIS were calculated. Clinical presentations, investigations and outcome of patients with IRIS were recorded. Baseline characteristics were compared between patients who developed IRIS and those who did not, and predictors for IRIS were identified. RESULTS : 14 cases of IRIS were diagnosed in a cohort of 109 patients initiated on HAART with an incidence of 12.8% (CI- 7.2-20.6%). The incidence of individual IRIS syndromes were: TB IRIS 8% (CI 3.8%, 15.1%), CMV IRIS 1.8% (CI 0.2%, 6.5%), Cryptococcal IRIS 1% (CI 0.02%,6.4%), PMLE IRIS 1% (CI 0.02%,6.4%) and Herpes zoster IRIS 1% (CI 0.02%,6.4%). The time to development of IRIS following initiation of HAART varied from 4-120 days with a mean of 33 days. 85% of patients developed IRIS within two months of initiation of HAART. In this study IRIS was associated with good outcomes. Clinical stage, BMI, baseline CD4 count, prior opportunistic infection, type of ART, timing of HAART treatment were not found to be significant risk factors in the development of IRIS. CONCLUSIONS : IRIS is an important clinical problem in this region which occurred at an incidence of 12.8% in this study. TB was the most common opportunistic infection presenting as IRIS which may be a reflection of the high prevalence of manifest or subclinical tuberculosis co-infection in patients with HIV being initiated on HAART in our setting. No significant predictors for IRIS were identified in this study. Outcomes in patients with IRIS appear to be fair with treatment of underlying opportunistic infections.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Immune Reconstitution Inflammatory Syndrome ; Incidence ; Characteristics ; Predictive factors.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 15 Feb 2018 18:12
Last Modified: 15 Feb 2018 18:12
URI: http://repository-tnmgrmu.ac.in/id/eprint/5730

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