Immune reconstitution inflammatory syndrome in HIV-infected patients with Pneumocystis jirovecii pneumonia

Tato, Luisa Roade; Burgos, Joaquín; Fábregas, Adrià Curran; Mercadèc), Jordi Navarro; Willekens, Rein; Gómez, Manuel; Pascuet, Esteban Ribera; Ferrer, Vicenç Falcó

doi:10.1016/j.eimce.2017.11.024

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…On the other hand, RNA-HIV viral loads >50 copies/mL showed a positive direction with paradoxical IRIS, similar to existing research [23]. However, on the contrary, some reports have shown that it is the dramatic reduction of RNA-HIV viral load levels after starting ART that significantly demonstrates IRIS development [24].…”

Section: Discussionsupporting

confidence: 85%

Paradoxical and Unmasking HIV Immune Reconstitution Inflammation Syndrome in Antiretroviral-Naïve Pregnant Women: A Prospective Cohort Study

Muthuka,

Nyamai,

Oluoch

et al. 2024

Cureus

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Background and aims: Following antiretroviral therapy (ART) initiation, HIV-associated immune reconstitution inflammatory syndrome (IRIS), indicated by an array of opportunistic infections, may occur, presenting as either paradoxical, a worsening of a previously treated infection, or unmasking, a flare-up of an underlying, previously undiagnosed infection. The impact of ART as the backbone of HIV treatment and prevention has prolonged the survival of people living with HIV. In pregnancy, benefits have been shown by slowing HIV progression and preventing perinatal transmission; however, there have been risks of adverse reactions with ART, including immune responses to both the fetus and mother. This study sought to estimate the incidence of HIV-IRIS cumulatively and by type either paradoxical or unmasking IRIS, determine the baseline maternal and HIV clinical markers as predictors of, and analyze the log-rank test for survival time to IRIS outcome assessed by relying on an increase in CD4 count and/or a rapid decrease in viral load. Methods: An active records study was conducted between June 2019 and March 2020 among ART-naïve pregnant women attending the antenatal care units (ANCu) at the Kenyatta National and Mbagathi Hospitals, Nairobi, Kenya. Participants were aged between 20 and 49 years and had a confirmed HIV-positive test. To ascertain a true case of IRIS, the diagnosis was adjudicated for accuracy and consistency by an independent review committee. Plasma HIV viral load, CD4 counts, and routine laboratory evaluations (hemoglobin, white blood cell count (WBC)) were performed by each hospital's clinical laboratory. The IRIS incidence was assessed using the International Network for Studies Against HIV-Associated IRIS (INSHI) during the first three months after ART initiation. Multivariate Cox regression with IRIS as the outcome, using the SPSSSurvival package, examined the relationship between baseline maternal characteristics and HIV clinical markers before ART initiation and IRIS, and finally, decision-tree analysis for predicting IRIS was performed. Results: From a pool of 532 ART-naïve pregnant women, 133 (25%) developed IRIS, and 97 (72.9%) were in the unmasking category. The accumulated risk of experiencing IRIS symptoms increased from week two (hazard ratio (HR)=0.0287) to week 12 (HR=3.6158). Participants with a maternal BMI (MBMI) of 25-29.9 kg/m 2 at baseline were at a higher risk of unmasking IRIS (HR=2.478; P=0.010). The WHO-HIV clinical stages 1 and 2 skewed towards paradoxical IRIS (regression coefficients =-0.111 and -0.276 (P<0.05)), while stage 4 skewed towards unmasking IRIS (regression coefficient=0.047, HR=1.048, P=0.941). A CD4 count > 500 cells/mm^3 skewed towards unmasking IRIS (regression coefficient=0.192, HR=1.211, P=0.416), while RNA-HIV viral loads >50 copies/ml towards paradoxical IRIS (regression coefficient=-0.199, HR=0.820, P=0.360. On decision tree analysis, 85% (P=0.001) of ART-naïve pregnant women with a baseline CD4 count...

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Section: Discussionsupporting

confidence: 85%

Paradoxical and Unmasking HIV Immune Reconstitution Inflammation Syndrome in Antiretroviral-Naïve Pregnant Women: A Prospective Cohort Study

Muthuka,

Nyamai,

Oluoch

et al. 2024

Cureus

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“…Lobar consolidation, nodules, mediastinal adenopathy and pleural effusions are uncommonly reported and these findings should prompt a search for an alternative pathology. Imaging findings of PJP‐IRIS are not widely published but worsening infiltrates, organizing pneumonia and granulomatous changes with nodules or masses have been described 5 . Imaging in this case was notable for development of consolidation within regions where ground glass abnormality had previously been demonstrated, with “respect” for boundaries of the earlier changes and unchanged well marginated peripheral sparing.…”

Section: Discussionmentioning

confidence: 73%

“…The majority of events occur within the first 8 weeks after ART initiation in those with HIV characterized by a high baseline viral load and CD4 < 200 cells/mm 3 2 . IRIS can occur with a decrease in viral load and no accompanying large increase in CD4 count 5 …”

Section: Discussionmentioning

confidence: 99%

The IRIS paradox: Imaging findings in a case of PJP‐IRIS

Reddy

Bajwa

Burke

2022

Respirology Case Reports

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Immune reconstitution inflammatory syndrome (IRIS) in patients with human immunodeficiency virus (HIV) and Pneumocystis jirovecii pneumonia infection reflects an exaggerated inflammatory response of the host immune system to an antigen, which is temporally related to recovery of the immune system. Clinical manifestations include fever, cough, dyspnoea and hypoxia following the commencement of antiretroviral therapy. Diagnosis is made on clinical and radiological criteria with exclusion of other infective and non‐infective causes. Unrecognized, IRIS may be associated with significant morbidity and mortality. Treatment with corticosteroids often results in prompt recovery. There is limited literature on radiological findings of Pneumocystis jirovecii pneumonia‐associated IRIS. Here we describe cross‐sectional imaging findings of PJP‐IRIS in a patient following commencement of antiretroviral therapy.

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“…In clinical practice, however, researchers have observed a unique phenomenon that HIV-patient with Pneumocystis jirovecii infection may experience an excessive inflammatory response which leads to further exacerbation after receiving potent anti-pneumocystis therapy and the rebuild of immune function. This phenomenon is called "immune reconstitution inflammatory syndrome (IRIS)" [1].…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 5% of patients with AIDS who were infected with Pneumocystis jirovecii developed IRIS. Because the pulmonary was the most commonly involved organ, about half of these patients may experience respiratory failure [1,2]. Non-AIDS immunosuppressed hosts may also show similar manifestations of IRIS during immune recovery [4].…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis jirovecii-associated immune reconstitution inflammatory syndrome-like phenomenon in a child with leukaemia: a case report and literature review

et al. 2022

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Background Immune reconstitution inflammatory syndrome (IRIS) refers to the phenomenon of intense immune responses against pathogens in patients with AIDS undergoing antiretroviral therapy to reconstitute immune function, resulting in functional impairment of multiple organs. Non-AIDS immunosuppressed hosts may also develop similar manifestations to IRIS during immune recovery. Case presentation An 8-year-old girl presented with acute lymphoblastic leukaemia was admitted for scheduled chemotherapy treatment. During chemotherapy, she experienced pancytopenia and Pneumocystis jirovecii pneumonia, which was diagnosed based on the abnormal shadows observed on chest computed tomography, the elevation of serum β-D-glucan, and the positive mNGS results of Pneumocystis jirovecii in both sputum and blood. After treatment with Granulocyte Colony-Stimulating Factor, sulfamethoxazole, and caspofungin, aggravation of lung lesions was discovered and severe interstitial lung disease developed in a short period along with a rapidly increasing leukocyte count. Intravenous methylprednisolone pulse therapy was given, but lung function did not improve, and she finally died after the withdrawal of medical care. Conclusions For patients with acute lymphocytic leukaemia infected with Pneumocystis jirovecii, the rapid aggravation of pulmonary lesions in the process of blood recovery and immune reconstitution should raise vigilance against the possibility of IRIS-like reactions. The use of granulocyte stimulating factors may aggravate the inflammatory response in the lungs. The timing, dosage, and duration of treatment of glucocorticoids and the impact of high-dose methylprednisolone pulse therapy on the prognosis of patients should be explored in further research.

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Immune reconstitution inflammatory syndrome in HIV-infected patients with Pneumocystis jirovecii pneumonia

Cited by 4 publications

References 25 publications

Paradoxical and Unmasking HIV Immune Reconstitution Inflammation Syndrome in Antiretroviral-Naïve Pregnant Women: A Prospective Cohort Study

Paradoxical and Unmasking HIV Immune Reconstitution Inflammation Syndrome in Antiretroviral-Naïve Pregnant Women: A Prospective Cohort Study

The IRIS paradox: Imaging findings in a case of PJP‐IRIS

Pneumocystis jirovecii-associated immune reconstitution inflammatory syndrome-like phenomenon in a child with leukaemia: a case report and literature review

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