期刊
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
卷 46, 期 4, 页码 456-462出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0b013e3181594c8c
关键词
AIDS; HIV; immune reconstitution disease; immune reconstitution inflammatory syndrome; paradoxical worsening; steroids
资金
- NHLBI NIH HHS [R01 HL71554] Funding Source: Medline
- NIAAA NIH HHS [R21 AA105032] Funding Source: Medline
- NIDA NIH HHS [K24 DA00432, R01 DA11602] Funding Source: Medline
Background: immune reconstitution inflammatory syndrome (IRIS), also called immune restoration disease, occurs in a subset of HIV-infected patients after the initiation of highly active antiretroviral therapy (HAART) and can be diagnostically challenging and difficult to treat. We sought to determine clinical risk factors for the development of IRIS. Methods: Patients from the Johns Hopkins HIV Clinic who had IRIS were identified and matched with 4 controls without IRIS who had initiated HAART within 6 months of the case. Results: Forty-nine cases of IRIS were identified; patients presented a median of 29 days from the initiation of HAART (range: 4 to 186 days). A multivariate analysis showed that the development of IRIS was independently associated with using a boosted protease inhibitor (BPI) (odds ratio [OR] = 7.41 ; P = 0.006), a nadir CD4 count < 100 cells/mm(3) (OR = 6.2; P < 0.001), and a plasma HIV viral RNA decrease of more than 2.5 log at the time of IRIS compared with RNA levels before the initiation of HAART. Incrementally greater decreases in viral loads directly correlated with increased risk for the development of IRIS. Conclusions: The most immunosuppressed patients treated with the most potent regimens, particularly BPI-based regimens, resulting in significant HIV viral load declines are at greatest risk for the development of IRIS after HAART initiation.
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