Risk factors for IRIS in HIV-associated Pneumocystis-pneumonia following ART initiation

Kann, Gerrit; Wetzstein, Nils; Bielke, Hannah; Schuettfort, Gundolf; Haberl, Annette; Wolf, Timo; Kuepper-Tetzel, Claus P.; Wieters, Imke; Kessel, Johanna; Leuw, Philipp de; Bickel, Markus; Khaykin, Pavel; Stephan, Christoph

doi:10.1016/j.jinf.2021.06.027

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Consistent with the findings of previous studies ( 8 – 10 ), we found that PLWH with IP who had a greater 1 month PVL decline with ART were at an increased risk for paradoxical IRIS when ART was started. However, our study revealed a higher rate (25.0%) of paradoxical IRIS during IP treatment than did previous studies (5 to 12.4%) ( 2 , 16 , 26 ). The reasons for the discrepancies in terms of the incidence of paradoxical IP-related IRIS that were observed between our study and other studies could be attributed to the IRIS definition that was used, the etiologies of IP, the timing of ART initiation, and the ART regimens initiated ( 2 , 16 , 26 ).…”

Section: Discussioncontrasting

confidence: 91%

“…We did not find that respiratory failure requiring intubation and mechanical ventilation or pneumothorax were related to paradoxical IRIS. However, the length of hospital stay was still significantly longer in our PLWH with IRIS due to the investigations and management required for IRIS, which was concordant with the results of Kann’s study that focused on PCP-related IRIS ( 16 ).…”

Section: Discussionsupporting

confidence: 89%

“…In a randomized clinical trial to assess the benefit of early versus deferred ART, it was revealed that PCP-related IRIS developed in 13 of 177 (7.3%) participants; of note, more than 85.0% of the included participants received protease inhibitor (PI)-based ART ( 2 ). In another retrospective study in 2021, paradoxical IRIS occurred in 12.4% of PLWH with PCP; however, data on the interval between PCP diagnosis and ART initiation were not available, and most included patients received PI-based ART (67.9%) ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Immune Reconstitution Inflammatory Syndrome in People Living with HIV Who Presented with Interstitial Pneumonitis: an Emerging Challenge in the Era of Rapid Initiation of Antiretroviral Therapy

et al. 2023

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Our study of PLWH who presented with IP mainly due to Pneumocystis jirovecii demonstrates that a high rate of paradoxical IRIS and a rapid decline of PVL with the initiation of ART, a CD4-to-CD8 ratio of <0.1 at baseline, and a short interval (<7 days) between the diagnosis of IP and the initiation of ART were associated with paradoxical IP-IRIS in PLWH. Paradoxical IP-IRIS was not associated with mortality or respiratory failure with heightened awareness among the HIV-treating physicians, rigorous investigations to exclude the possibilities of concomitant infections, or the malignancies and adverse effects of medications, including the cautious use of corticosteroids.

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Immune Reconstitution Inflammatory Syndrome in People Living with HIV Who Presented with Interstitial Pneumonitis: an Emerging Challenge in the Era of Rapid Initiation of Antiretroviral Therapy

et al. 2023

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“…However, the finding of M. Colombiense and its anti-NTM treatment proved the patient has an “unmasking” IRIS. Previous studies [ [21] , [22] , [23] ] demonstrated baseline predictors, such as low CD4 count, low BMI, high HIV viral load, and low hemoglobin significantly increased the risk of developing IRIS. The patient had a baseline CD4 + count of 95 copies/ul, BMI of 16.85, HIV viral load of 1.44*10^5 copies/ml, and anemia, which helped him develop the IRIS.…”

Section: Discussionmentioning

confidence: 99%

Coinfection of Cytomegalovirus, Pneumocystis jirovecii pneumonia, COVID-19, and Mycobacterium colombiense in an AIDS patient: A case report

Zuo,

Zheng,

et al. 2024

Heliyon

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Clinical characteristics and prognosis of Talaromycosis marneffei associated immune reconstitution inflammatory syndrome in AIDS patients

Zhang,

Guo

et al. 2024

PLoS Negl Trop Dis

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Background Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory reaction that occurs in HIV/AIDS patients after antiretroviral therapy (ART) initiation. Along with immune system recovery, IRIS can overreact to existing infections or latent pathogens, causing symptoms that mimic those infections. Few studies elucidated the clinical features and prognosis of Talaromycosis marneffei (TSM)-associated IRIS in HIV/AIDS patients. The aim of our study was to evaluate the incidence, clinical characteristics, and prognosis of TSM-associated IRIS by retrospectively analyzing the clinical data of HIV/AIDS patients with TSM. Methodology/Principal findings A total of 224 HIV/AIDS inpatients with TSM were enrolled, aged between 19 and 81 years. Among them, 86.6% were male and 13.4% were female, of which 24 (10.7%) patients developed IRIS. In IRIS group, the median time from ART initiation to IRIS occurrence was 9.0 days (IQR, 5.0–16.8 days), with 87.5% (21/24) occurring within 2 weeks. Primary clinical manifestations included recurrent fever and exacerbation of pulmonary infection. At the onset of IRIS, 54.2% (13/24) patients were treated with intravenous dexamethasone, and 12.5% (5/24) patients were treated with oral prednisone for 1–3 weeks. No significant differences in baseline characteristics or ART regimens were observed between IRIS and non-IRIS groups; however, patients in IRIS group had higher levels of CRP, CD4+ count, and CD4+/CD8+ ratio than non-IRIS group (equivalent time point: 1–2 weeks after ART initiation) at IRIS onset. The IRIS group exhibited longer hospital stays and higher readmission rates, but equivalent mortality rates compared with non-IRIS group. Conclusions/Significance IRIS is a common complication in HIV/AIDS patients with TSM, often occurring within 2 weeks after ART initiation and exhibiting more pronounced immune reconstitution. The occurrence of IRIS significantly extended the hospitalization duration and increased the rate of readmission but had no influence on the mortality rate.

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Risk factors for IRIS in HIV-associated Pneumocystis-pneumonia following ART initiation

Cited by 4 publications

References 18 publications

Immune Reconstitution Inflammatory Syndrome in People Living with HIV Who Presented with Interstitial Pneumonitis: an Emerging Challenge in the Era of Rapid Initiation of Antiretroviral Therapy

Immune Reconstitution Inflammatory Syndrome in People Living with HIV Who Presented with Interstitial Pneumonitis: an Emerging Challenge in the Era of Rapid Initiation of Antiretroviral Therapy

Coinfection of Cytomegalovirus, Pneumocystis jirovecii pneumonia, COVID-19, and Mycobacterium colombiense in an AIDS patient: A case report

Clinical characteristics and prognosis of Talaromycosis marneffei associated immune reconstitution inflammatory syndrome in AIDS patients

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