scholarly journals Paradoxical immune reconstitution inflammatory syndrome associated with cryptococcal meningitis in China: a 5-year retrospective cohort study

2015 ◽  
Vol 21 (4) ◽  
pp. 379.e11-379.e14
Author(s):  
S. Yan ◽  
L. Chen ◽  
W. Wu ◽  
Z. Li ◽  
Z. Fu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Retrospective Cohort Study ◽  
Cryptococcal Meningitis ◽  
Retrospective Cohort ◽  
Immune Reconstitution ◽  
Inflammatory Syndrome

scholarly journals Immune Reconstitution Inflammatory Syndrome During the First Six Months of Receiving Antiretroviral in HIV-Infected Individuals: A Retrospective Cohort Study

2019 ◽  
Vol 3 (1) ◽  
pp. 01-04
Author(s):  
Faustine Tungaraza ◽  
Augustino S. Kahere ◽  
George M. Bwire ◽  
Doreen Mloka ◽  
Fatuma F. Felician
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Immune Reconstitution ◽  
Cd4 Cells ◽  
Inflammatory Syndrome

Introduction: Immune reconstitution inflammatory syndrome (IRIS) is referred to as the flare up of an underlying, previously undiagnosed infection or the worsening of a previously treated infection soon after antiretroviral therapy (ART) is started. Information about the prevalence and associated risk factors for IRIS in resource-constrained countries like Tanzania where access to ART is increasing is scarce. Therefore, this study was conducted to determine the prevalence and risk factors associated with IRIS among patients attending care and treatment clinic at Muhimbili National Hospital (CTC-MNH). Methods: A retrospective cohort study was conducted in patients receiving highly active antiretroviral therapy (HAART) who attended CTC-MNH between July 2016 and June 2018. Mann Whitney test was used to compare median CD4+ cells count and viral load at baseline and after 6 months of treatment. Associated factors were analysed using multi-logistic regression. Statistics were done using GraphPad Prism 7 software and a p-value < 0.05 was considered statistically significant. Results: Of 318 patients, 8.5% encountered IRIS. Compared to baseline readings, there were significant increases in CD4+ cells (P < 0.0001) and decrease in viral load count (P < 0.0001). Patients who did not adhere to HAART were more likely to develop IRIS [Adjusted Odds Ratio (AOR) = 4.2, 95% CI; 1.14-15.60, P = 0.03]. Conclusion: This study found relatively low prevalence of IRIS as compared to those reported elsewhere. Moreover, poor adherence to HAART was found to be a risk factor for IRIS.

scholarly journals Declines in Lung Function After Antiretroviral Therapy Initiation in Adults With Human Immunodeficiency Virus and Tuberculosis: A Potential Manifestation of Respiratory Immune Reconstitution Inflammatory Syndrome

2019 ◽  
Vol 70 (8) ◽  
pp. 1750-1753 ◽  
Author(s):  
Sara C Auld ◽  
Pholo Maenetje ◽  
Shruthi Ravimohan ◽  
Drew Weissman ◽  
Itai Ncube ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Lung Function ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Research Attention ◽  
Therapy Initiation ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

Abstract End-organ impairment has received relatively little research attention as a possible manifestation of tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS). In this prospective cohort study, one-half of adults with human immunodeficiency virus and pulmonary tuberculosis experienced meaningful declines in lung function on antiretroviral therapy, suggesting a role for lung function in TB-IRIS definitions.

scholarly journals Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

2016 ◽  
Vol 28 (5) ◽  
pp. 480-485 ◽  
Author(s):  
J Hiesgen ◽  
C Schutte ◽  
S Olorunju ◽  
J Retief
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Mortality Risk ◽  
Retrospective Cohort Study ◽  
Cryptococcal Meningitis ◽  
Retrospective Cohort ◽  
Nausea And Vomiting ◽  
People Living With Hiv

Aim This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient’s socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. Methods Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients’ mortality risk. Results A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2–81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6–131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7–23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. Conclusion Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

scholarly journals HIV-Associated Cryptococcal Immune Reconstitution Inflammatory Syndrome is Associated with Aberrant T Cell Function and Increased Cytokine Responses

2019 ◽  
Author(s):  
David B. Meya ◽  
Samuel Okurut ◽  
Godfrey Zziwa ◽  
Stephen Cose ◽  
David R. Boulware ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Opportunistic Infection ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Cryptococcal Meningitis ◽  
Immune Reconstitution ◽  
T Cell Memory ◽  
Cell Memory ◽  
Cytokine Responses ◽  
Inflammatory Syndrome

Cryptococcal meningitis remains a significant opportunistic infection among HIV-infected patients, contributing 15%-20% of HIV-related mortality. A complication of initiating Antiretroviral therapy (ART) following opportunistic infection is Immune Reconstitution Inflammatory Syndrome (IRIS). IRIS afflicts 10-30% of HIV-infected patients with cryptococcal meningitis (CM), but its immunopathogenesis is poorly understood. We compared circulating T cell memory subsets and cytokine responses among 17 HIV-infected Ugandans with CM: 11 with and 6 without CM-IRIS. At meningitis diagnosis, stimulation with cryptococcal capsule component, glucuronoxylomannan (GXM) elicited consistently lower frequencies of CD4+ and CD8+ T cell memory subsets expressing intracellular cytokines (IL-2, IFN-&gamma; and IL-17) among subjects who subsequently developed CM-IRIS. After ART initiation, T cells evolved to show a decreased CD8+ central memory phenotype. At the onset of CM-IRIS, stimulation more frequently generated polyfunctional IL-2+/IL-17+ CD4+ T cells in patients with CM-IRIS. Moreover, CD8+ central and effector memory T cells from CM-IRIS subjects also demonstrated more robust IL-2 responses to antigenic stimulation vs. controls. Thus, ART during CM elicits distinct differences in T cell cytokine production in response to cryptococcal antigens both prior to and during the development of IRIS, suggesting an immunologic foundation for the development of this morbid complication of CM infection.

Sign in / Sign up

Export Citation Format

Share Document