TY - JOUR
T1 - The Epidemiology of IRIS in Southern India
T2 - An Observational Cohort Study
AU - Thambuchetty, Nisha
AU - Mehta, Kayur
AU - Arumugam, Karthika
AU - Shekarappa, Umadevi G.
AU - Idiculla, Jyothi
AU - Shet, Anita
N1 - Funding Information:
The authors thank the staff at the ART Center, St John’s Medical College Hospital, for their excellent teamwork and patient care. The authors acknowledge the National AIDS Control Organisation (NACO), Government of India, and the Karnataka AIDS Prevention Society (KSAPS) for providing support for these patients. The authors are ever grateful to the study patients for participating in this study. The authors acknowledge partial support from the Wellcome Trust/ Department of Biotechnology India Alliance Senior Fellowship (IA/S/ 13/2/501017) awarded to AS.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was partially supported by Wellcome Trust/Department of Biotechnology India Alliance Senior Fellowship (IA/S/13/2/501017).
Publisher Copyright:
© SAGE Publications.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Immune reconstitution inflammatory syndrome (IRIS) is an uncommon but dynamic phenomenon seen among patients initiating antiretroviral therapy (ART). We aimed to describe incidence, risk factors, clinical spectrum, and outcomes among ART-naive patients experiencing IRIS in southern India. Among 599 eligible patients monitored prospectively between 2012 and 2014, there were 59.3% males, with mean age 36.6 ± 7.8 years. Immune reconstitution inflammatory syndrome incidence rate was 51.3 per 100 person-years (95% confidence interval: 44.5-59.2). One-third (31.4%) experienced at least 1 IRIS event, at a median of 27 days since ART initiation. Mucocutaneous infections and candidiasis were common IRIS events, followed by tuberculosis. Significant risk factors included age >40 years, body mass index <18.5 kg/m2, CD4 count <100 cells/mm3, viral load >10 000 copies/mL, hemoglobin <11 g/dL, and erythrocyte sedimentation rate >50 mm/h. Immune reconstitution inflammatory syndrome-related morality was 1.3% (8 of 599); 3 patients died of complicated diarrhea. These findings highlight the current spectrum of IRIS in South India and underscore the importance of heightened vigilance for anemia and treatment of diarrhea and candidiasis during ART initiation.
AB - Immune reconstitution inflammatory syndrome (IRIS) is an uncommon but dynamic phenomenon seen among patients initiating antiretroviral therapy (ART). We aimed to describe incidence, risk factors, clinical spectrum, and outcomes among ART-naive patients experiencing IRIS in southern India. Among 599 eligible patients monitored prospectively between 2012 and 2014, there were 59.3% males, with mean age 36.6 ± 7.8 years. Immune reconstitution inflammatory syndrome incidence rate was 51.3 per 100 person-years (95% confidence interval: 44.5-59.2). One-third (31.4%) experienced at least 1 IRIS event, at a median of 27 days since ART initiation. Mucocutaneous infections and candidiasis were common IRIS events, followed by tuberculosis. Significant risk factors included age >40 years, body mass index <18.5 kg/m2, CD4 count <100 cells/mm3, viral load >10 000 copies/mL, hemoglobin <11 g/dL, and erythrocyte sedimentation rate >50 mm/h. Immune reconstitution inflammatory syndrome-related morality was 1.3% (8 of 599); 3 patients died of complicated diarrhea. These findings highlight the current spectrum of IRIS in South India and underscore the importance of heightened vigilance for anemia and treatment of diarrhea and candidiasis during ART initiation.
KW - AIDS
KW - HIV
KW - IRIS
KW - anemia
KW - candidiasis
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U2 - 10.1177/2325957417702485
DO - 10.1177/2325957417702485
M3 - Article
C2 - 28399724
AN - SCOPUS:85029490266
SN - 2325-9574
VL - 16
SP - 475
EP - 480
JO - Journal of the International Association of Providers of AIDS Care
JF - Journal of the International Association of Providers of AIDS Care
IS - 5
ER -