13th Annual Conference of the British HIV Association 29 March–1 April 2007, Brighton, UK

IMMUNE RECONSTITUTION SYNDROME IN HIV-ASSOCIATED CRYPTOCOCCAL MENINGITIS: INCIDENCE, RISK FACTORS, CLINICAL FEATURES AND CSF IMMUNE RESPONSE

HIV Med 2007; 8(Suppl. 1):3 (abstract no. O11)

Tihana Bicanic¹, Graeme Meintjes², Robin Wood³, Madeleine Hayes¹, Kevin Rebe², Angela Loyse¹, Linda-Gail Bekker³ and Thomas Harrison^1
1St George’s Hospital Medical School, London, UK, ²Department of Medicine, GF Jooste Hospital, Cape Town, South Africa, ³Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa

OBJECTIVE: The objectives were (i) to prospectively determine incidence, characteristics of, and risk factors for the development of immune reconstitution syndrome in patients with cryptococcal meningitis (CM-IRIS) started on antiretroviral therapy and (ii) to compare CSF parameters between first CM episode and IRIS episode in those developing CM-IRIS.

METHODS: Prospective observational study of HIV-infected CM patients subsequently started on ART (n=65) in Cape Town, South Africa, May ’05–Dec ‘06. CM-IRIS defined as: (i) CSF culture-confirmed first CM episode; (ii) complete resolution of symptoms prior to starting ART; (iii) self-reported adherence to fluconazole and ART; (iv) recurrence of symptoms after initiation of ART; (v) positive CSF cryptococcal antigen; (vi) evidence of immunologic and virological response to ART; and (vii) no alternative diagnosis.

RESULTS: Median time from CM diagnosis to start of ART was 47 days. After 11 months median follow-up, 11 of 65 patients (17%) had developed CM-IRIS, of whom three died. There were no significant differences in fungal burden at start or end of therapy, rate of fungal clearance or CSF parameters for first CM episode, baseline CD4, HIV viral load, or time to ART initiation, between patients who subsequently did or did not develop CM-IRIS. Median CD4 rise from baseline to 6 months on ART was significantly greater in patients developing IRIS (220 versus 124 × 10⁶/L, P=0.01). CSF parameters did not differ between first CM and CM-IRIS in 11 patients developing CM-IRIS (CSF cytokines to be analysed).

CONCLUSION: In our cohort CM-IRIS was common (17%) and had a high mortality. No factors at first CM episode predicted those at risk of developing CM-IRIS. Patients developing CM-IRIS showed a greater response to ART at 6 months.

2007-03-29
O11

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