Incidence and Risk Factors for Immune Reconstitution Inflammatory Syndrome in an Ethnically Diverse HIV Type 1-Infected Cohort

Ratnam, Irani; Chiu, Chen‐Yuan; Kandala, Ngianga‐Bakwin; Easterbrook, Philippa

doi:10.1086/499356

Cited by 306 publications

(252 citation statements)

References 26 publications

(60 reference statements)

Supporting

Mentioning

219

Contrasting

Unclassified

Order By: Relevance

“…This is further supported by the presence of a positive lepromin test in some of the multibacillary patients. Among the risks factors associated to the development of IRIS, male gender (Shelburne et al, 2005), young age (Ratnam et al, 2006), and immune suppression (Shelburne et al, 2005;Ratnam et al, 2006) were also observed in the present series. Other risk factors, such as short interval between initiating treatment for opportunistic infection (OI), a rapid fall in HIV-1 RNA after HAART, and being ART naïve at the time of OI diagnosis were observed in most of the patients (Shelburne et al, 2005).…”

Section: Discussionsupporting

confidence: 78%

“…Other risk factors, such as short interval between initiating treatment for opportunistic infection (OI), a rapid fall in HIV-1 RNA after HAART, and being ART naïve at the time of OI diagnosis were observed in most of the patients (Shelburne et al, 2005). Additional significant predictors include a lower baseline CD4 cell percentage, a lower CD4 cell count at ART initiation, and a lower CD4 to CD8 cell ratio at baseline were observed in a few cases (Ratnam et al, 2006). In the same way, a higher baseline CD8 cell count is associated with IRIS as CD8 cell counts represent the presence of immune activation [29, 36, 37] (Ratnam et al, 2006) (Robertson et al, 2006) (Cianchetta-Sivori et al, 2007.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reversal Reaction as a Manifestation of Immune Reconstitution Inflammatory Syndrome

Menezes¹,

Sales²,

Nery³

et al. 2011

Recent Translational Research in HIV/AIDS

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Reversal Reaction as a Manifestation of Immune Reconstitution Inflammatory Syndrome

Menezes¹,

Sales²,

Nery³

et al. 2011

Recent Translational Research in HIV/AIDS

View full text Add to dashboard Cite

“…9 The possibility that HL could be triggered by immune reconstitution has not been established, but this is implied by the elevated risk of HL observed in the 3 months after cART initiation, which is the typical interval for IRIS to manifest. 15,16,32 Assessment of changes in EBV infection during immune reconstitution, such as increased expression of LMP-1 in germinal-center or circulating B cells, would support this possibility.…”

Section: Discussionmentioning

confidence: 99%

HIV-associated Hodgkin lymphoma during the first months on combination antiretroviral therapy

Lanoy

Rosenberg

Fily

et al. 2011

Blood

View full text Add to dashboard Cite

Hodgkin lymphoma (HL) incidence with HIV infection may have increased with the introduction of combination antiretroviral therapy (cART), suggesting that immune reconstitution may contribute to some cases. We evaluated HL risk with cART during the first months of treatment. With 187 HL cases among 64 368 HIV patients in France, relative rates (RRs) and 95% confidence intervals (CIs) of HL were estimated using Poisson models for duration of cART, CD4 count, and HIV load, with and without adjustment for demographic/ clinical covariates. HL risk was unrelated to cART use overall, but it was related to time intervals after cART initiation (P ‫؍‬ .006). Risk was especially and significantly elevated in months 1-3 on cART (RR 2.95, CI 1.64-5.31), lower in months 4-6 (RR 1.63), and null with longer use (RR 1.00). CD4 count was strongly associated with HL risk (P < 10 ؊6 ), with the highest HL incidence at 50-99 CD4 cells/mm 3 . With adjustment for CD4 count and covariates, HL risk was elevated, but not significantly (RR 1.42), in months 1-3 on cART. HIV load had no added effect. HL risk increased significantly soon after cART initiation, which was largely explained by the CD4 count. IntroductionHodgkin lymphoma (HL) incidence is significantly elevated in the HIV-infected population. [1][2][3] In addition, since the advent of combination antiretroviral therapy (cART) in 1996, studies in the United States 4 and the United Kingdom 5 have reported an increase in the incidence of HL compared with the pre-cART era. For example, among people with AIDS in the United States, the incidence of HL was shown to be elevated 8-fold compared with the general population during the pre-cART era, and this increased significantly to 13-fold during the cART era. 1 Excess risk of HL in a second US population and among the HIV-infected population in France was shown to be very high during the pre-cART era. 2,6 In the French study, HL incidence increased even more (by 1.4-fold) during the cART era compared with the pre-cART era. 2 In the Swiss HIV Cohort Study, HL risk was 3-fold higher in the cART era compared with the pre-cART era in an analysis of the first 18 cases, 7 but this was not statistically significant and no increment in the cART era was found in an updated analysis of 47 HL cases. 8 Increased HL in the cART era has been postulated to be related to the actual use of cART, with a potential role for immunologic mechanisms. 2,4,9 Some support for an effect of cART on HL risk was provided by the British and initial Swiss studies, but these findings were marginally significant and were adjusted little or not at all for immune deficiency. 5,7 The British study also suggested that the excess risk of HL might specifically relate to the use of non-nucleoside reverse transcriptase inhibitors (NNRTIs). 5 Immune perturbation, and its control by cART, is likely to be integral to the development of HIV-associated HL. The relative risk (RR) of HIV-associated HL is 3.5-fold higher after AIDS onset, 10 and a lower CD4 lymphocyte count generally ...

show abstract

“…Neurological disease following initiation of ART due to inflammation associated with previously silent M. tuberculosis infection in the CNS is a particular concern and may have a poor outcome (93). Several studies describe expanding intracranial tuberculomas (11,34,35,118,120,148), and acute onset of TB meningitis has been reported (35).…”

Section: Introductionmentioning

confidence: 99%

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

et al. 2009

View full text Add to dashboard Cite

SUMMARY Up to one in four patients infected with human immunodeficiency virus type 1 and given antiretroviral therapy (ART) experiences inflammatory or cellular proliferative disease associated with a preexisting opportunistic infection, which may be subclinical. These immune restoration diseases (IRD) appear to result from the restoration of immunocompetence. IRD associated with intracellular pathogens are characterized by cellular immune responses and/or granulomatous inflammation. Mycobacterial and cryptococcal IRD are attributed to a pathological overproduction of Th1 cytokines. Clinicopathological characteristics of IRD associated with viral infections suggest different pathogenic mechanisms. For example, IRD associated with varicella-zoster virus or JC polyomavirus infection correlate with a CD8 T-cell response in the central nervous system. Exacerbations or de novo presentations of hepatitis associated with hepatitis C virus (HCV) infection following ART may also reflect restoration of pathogen-specific immune responses as titers of HCV-reactive antibodies rise in parallel with liver enzymes and plasma markers of T-cell activation. Correlations between immunological parameters assessed in longitudinal sample sets and clinical presentations are required to illuminate the diverse immunological scenarios described collectively as IRD. Here we present salient clinical features and review progress toward understanding their pathogeneses.

show abstract

Incidence and Risk Factors for Immune Reconstitution Inflammatory Syndrome in an Ethnically Diverse HIV Type 1-Infected Cohort

Cited by 306 publications

References 26 publications

Reversal Reaction as a Manifestation of Immune Reconstitution Inflammatory Syndrome

Reversal Reaction as a Manifestation of Immune Reconstitution Inflammatory Syndrome

HIV-associated Hodgkin lymphoma during the first months on combination antiretroviral therapy

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Contact Info

Product

Resources

About