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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early vs. deferred ART during an opportunistic infection
PLoS ONE, Volume 5, No. 7, Article e11416, Year 2010
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Description
Background: Immune reconstitution inflammatory syndrome (IRIS) is reported widely in patients initiating antiretroviral therapy (ART). However, few studies are prospective, and no study has evaluated the impact of the timing of ART when allocated randomly during an acute opportunistic infection (OI). Methodology/PrincipalFindings: A5164 randomized 282 subjects with AIDS-related OIs (tuberculosis excluded), to early or deferred ART. IRIS was identified prospectively using pre-defined criteria. We evaluated associations between IRIS and baseline variables in subjects with follow-up on ART using Wilcoxon and Fisher's exact tests, logistic regression, and Cox models with time-varying covariates. Twenty of 262 (7.6%) subjects developed IRIS after a median of 33 days on ART. Subjects with fungal infections (other than pneumocystis) developed IRIS somewhat more frequently (OR = 2.7;95% CI: 1.02, 7.2;p-value = 0.06 (using Fisher's exact test)). In Cox models, lower baseline and higher on-treatment CD4+ T-cell counts and percentage were associated with IRIS. Additionally, higher baseline and lower on-treatment HIV RNA levels were associated with IRIS. Corticosteroids during OI management and the timing of ART were not associated with the development of IRIS. Impl cat ons: In patients with advanced immunosuppression and non-tuberculous OIs, the presence of a fungal infection, lower CD4+ T-cell counts and higher HIV RNA levels at baseline, and higher CD4+ T-cell counts and lower HIV RNA levels on treatment are associated with IRIS. Early initiation of ART does not increase the incidence of IRIS, and concern about IRIS should not prompt deferral of ART. © 2010 Grant et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2895658/bin/pone.0011416.s001.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC2895658/bin/pone.0011416.s002.doc
Authors & Co-Authors
Grant, Philip M.
Unknown Affiliation
Komarow, Lauren
Unknown Affiliation
Andersen, Janet W.
Unknown Affiliation
Sereti, Irini
Unknown Affiliation
Pahwa, Savita G.
Unknown Affiliation
Lederman, Michael M.
Unknown Affiliation
Eron, Joseph J.
Unknown Affiliation
Sanne, Ian
Unknown Affiliation
Powderly, William G.
Unknown Affiliation
Hogg, Evelyn
Unknown Affiliation
Suckow, Carol
Unknown Affiliation
Zolopa, Andrew R.
Unknown Affiliation
Statistics
Citations: 149
Authors: 12
Affiliations: 12
Identifiers
Doi:
10.1371/journal.pone.0011416
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cohort Study