Immune reconstitution inflammatory syndrome in a resource-poor setting

Stephen A Klotz, Abdul Aziz Mohammed, Mulugeta Girmai Woldemichael, Mongistu Worku Mitku, Mitchell Handrich

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm 3. Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.

Original languageEnglish (US)
Pages (from-to)122-127
Number of pages6
JournalJournal of the International Association of Physicians in AIDS Care
Volume8
Issue number2
DOIs
StatePublished - Mar 2009

Fingerprint

Immune Reconstitution Inflammatory Syndrome
Highly Active Antiretroviral Therapy
Cryptococcal Meningitis
Pneumocystis carinii
Pneumocystis Pneumonia
Lost to Follow-Up
Toxoplasmosis
Gastroenteritis
CD4 Lymphocyte Count
Ambulatory Care Facilities

Keywords

  • Africa
  • AIDS
  • Ethiopia
  • gastroenteritis
  • IRIS

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology
  • Dermatology
  • Medicine(all)

Cite this

Immune reconstitution inflammatory syndrome in a resource-poor setting. / Klotz, Stephen A; Aziz Mohammed, Abdul; Girmai Woldemichael, Mulugeta; Worku Mitku, Mongistu; Handrich, Mitchell.

In: Journal of the International Association of Physicians in AIDS Care, Vol. 8, No. 2, 03.2009, p. 122-127.

Research output: Contribution to journalArticle

Klotz, Stephen A ; Aziz Mohammed, Abdul ; Girmai Woldemichael, Mulugeta ; Worku Mitku, Mongistu ; Handrich, Mitchell. / Immune reconstitution inflammatory syndrome in a resource-poor setting. In: Journal of the International Association of Physicians in AIDS Care. 2009 ; Vol. 8, No. 2. pp. 122-127.
@article{01ea4666f2824e159594ee393f7bc407,
title = "Immune reconstitution inflammatory syndrome in a resource-poor setting",
abstract = "The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm 3. Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7{\%} of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99{\%} by 6 months. Of those hospitalized with IRIS, 4 patients (5{\%}) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50{\%} of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.",
keywords = "Africa, AIDS, Ethiopia, gastroenteritis, IRIS",
author = "Klotz, {Stephen A} and {Aziz Mohammed}, Abdul and {Girmai Woldemichael}, Mulugeta and {Worku Mitku}, Mongistu and Mitchell Handrich",
year = "2009",
month = "3",
doi = "10.1177/1545109709332469",
language = "English (US)",
volume = "8",
pages = "122--127",
journal = "Journal of the International Association of Physicians in AIDS Care",
issn = "1545-1097",
publisher = "SAGE Publications Inc.",
number = "2",

}

TY - JOUR

T1 - Immune reconstitution inflammatory syndrome in a resource-poor setting

AU - Klotz, Stephen A

AU - Aziz Mohammed, Abdul

AU - Girmai Woldemichael, Mulugeta

AU - Worku Mitku, Mongistu

AU - Handrich, Mitchell

PY - 2009/3

Y1 - 2009/3

N2 - The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm 3. Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.

AB - The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm 3. Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.

KW - Africa

KW - AIDS

KW - Ethiopia

KW - gastroenteritis

KW - IRIS

UR - http://www.scopus.com/inward/record.url?scp=66149177156&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66149177156&partnerID=8YFLogxK

U2 - 10.1177/1545109709332469

DO - 10.1177/1545109709332469

M3 - Article

VL - 8

SP - 122

EP - 127

JO - Journal of the International Association of Physicians in AIDS Care

JF - Journal of the International Association of Physicians in AIDS Care

SN - 1545-1097

IS - 2

ER -