Vol.69 No.6 November 2021
Immune reconstitution inflammatory syndrome: report of a 20 years' experience at a local AIDS core hospital
1)Center for Health Control, Nara Medical University, 840 Shijo, Kashihara, Nara, Japan
2)Center for Infectious Diseases, Nara Medical University
3)Department of Infectious Diseases, Minami-Nara General Medical Center
Abstract
Some patients with HIV infection have been reported to develop paradoxical worsening of pre-existing infectious/inflammatory processes, the so-called immune reconstitution inflammatory syndrome (IRIS), after the initiation of antiretroviral therapy (ART). While some reports have been published previously on the incidence of IRIS, the precise incidence in Japan has not yet been fully explored. In this study, we investigated the incidence of IRIS in HIV-infected patients treated at a local AIDS core hospital over a period of 20 years, with the aim of determining the impact of IRIS on the clinical practice in path adopted for HIV-infected patients.
This study was conducted in HIV-infected patients in whom ART was initiated (or resumed), or previous therapy was switched to ART due to poor response, between January 1997 and December 2016, and was virologically effective. The incidence of IRIS, the diseases encountered as IRIS, disease status, and clinical course of the patients with IRIS were investigated.
A total of 172 patients were included in the analysis. Twenty-seven patients (15.7%) developed IRIS, with a total of 31 events. The first case of IRIS was encountered in 1999. Cases were predominantly encountered between 2009 and 2014. A total of 12 diseases occurred as IRIS in the patients: the most frequent was herpes zoster (10 patients), followed by nontuberculous mycobacterial infections (3 patients), cytomegalovirus infection (3 patients), and Graves disease (3 patients). IRIS developed within 3 months of initiation of ART in 80.6% of patients, except for Graves disease, which developed 2 years or more after the initiation of ART. Development of paradoxical IRIS was observed in 10 patients. There were no characteristic relationships between the development of IRIS and the class of anti-HIV drugs used. Sequelae of IRIS were observed in 3 patients. Therapy for IRIS was continued in 3 patients.
The incidence of IRIS at our hospital was approximately 15%, indicating that IRIS is a relatively commonly encountered pathologic condition in HIV clinical practice. Various diseases were encountered as IRIS events. Some patients had sequelae or required long-term treatment. Clinicians should be aware of the risk of development of IRIS after the initiation of ART.
Key word
HIV infection, immune reconstitution inflammatory syndrome, herpes zoster, cytomegalovirus infection, nontuberculous mycobacterial infections
Received
September 2, 2021
Accepted
September 17, 2021
Jpn. J. Chemother. 69 (6): 425-432, 2021
