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14th Annual Conference of the British HIV Association23–25 April 2008, Belfast |
HIGH INCIDENCE OF IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) DUE TO DERMATOLOGICAL CONDITIONS AND TUBERCULOSIS IN AN ART PROGRAMME IN SOUTH AFRICA
HIV Med 2008; 9(Suppl. 1):5 (abstract no. O17)
LJ Haddow1, MYS Moosa2, NG Khanyile2, NM Sithole2, Q Zulu2, A Mosam2, F Ibrahim1 and PJ Easterbrook1
1King’s College Medical School, London, UK, 2University of KwaZulu-Natal, Durban, South Africa
BACKGROUND: There are few data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in resource-limited settings. We estimated the incidence, clinical spectrum and risk factors for IRIS, and its contribution to mortality in an ART programme in South Africa.
METHODS: Prospective cohort study of 499 patients initiating ART between 12/06 and 10/07 at two hospital-based public clinics. Patients were monitored monthly for the first 6 months for IRIS events, diagnosed according to consensus expert opinion. Logistic regression model was used to evaluate Odds Ratios (OR) of potential risk factors for IRIS.
RESULTS: At ART initiation, 25% of 499 patients were male, median age 34 years (IQR 29-40), CD4+ 105 cells/mm3 (IQR 53-165), viral load 4.9 log10 copies/mL (IQR 4.3-5.5), 64% WHO stage 3-4. Mean follow-up by 12/07 was 20 weeks (total 187 patient-years [PY]). One hundred and forty IRIS events occurred in 113 patients (22.6% [95% CI 19.0–26.3%]; incidence rate 74.9/100 PY) after median 21 days (IQR 7-49). Commonest IRIS diagnoses were eosinophilic folliculitis (24% of IRIS cases), TB (24%), genital ulcer disease (11%), herpes zoster (7%) and tinea (6%). Six of 24 (25%) deaths, 15/65 (23%) hospital admissions, and 6/38 (16%) ART discontinuations or regimen changes were due to IRIS. Most significant risk factors for IRIS were baseline viral load >5.0 log10 (OR 2.3, 95% CI 1.4–3.8, p=0.001), baseline CD4 <100 (OR 1.8, 95% CI 1.1– 2.8, p=0.022) and current TB (OR 2.2, 95% CI 1.2–3.9, p=0.007).
CONCLUSIONS: IRIS occurred in 23% of patients and was more frequent in patients with advanced disease; most cases were dermatological. Despite low overall mortality, IRIS contributed to 25% of all deaths.
2008-04-23
O17
Copyright © 2008 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD