gms | German Medical Science

Objectives: The immunereconstitution inflammartory syndrome (IRIS) is a disturbance of immunerestoration that causes morbidity and mortality in patients commencing HAART. It occurs with a frequency of 10–25% of patients. It has mainly been investigated in an African setting. The pattern of opportunistic diseases and timing of initiation of HAART vary in different regions of the world. To date IRIS has not been prospectively investigated in the western world.

Methods: Prospective cohort-study of HIV-positive patients initiating HAART at 3 centers for occurance of IRIS

Results: We present 12 week results. Data are available for 113 patients, IRIS was observed in 28 patients (24,8%). Folliculitis was the most common IRIS-event (n=7), followed by herpes zoster and exacerbation of pre-existing dermatitis (n=5 each), third most common manifestations were re-activation of CMV and HBV (n=4 each). The majority of events occurred within 6 weeks of initiation of HAART. There was no statistically significant difference in CD4-cellcount, plasma viral load, age, gender or ethnicity between patients developing IRIS and those who did not. However, patients developing IRIS had statistically significantly more often concomitant infections of any kind as well as more coinfections in a single patient than patients not developing IRIS. Nevertheless, only 10 IRIS-events were related to preexisting infections. A subgroup of patients received prophylactic low-dose prednisolon, but there was no statistically significant difference in the frequency of IRIS in patients receiving prednisolon and those who did not.

Conclusions: Although the frequency of IRIS-events is similar to previously reported studies, the spectrum of clinical manifestations differs greatly from previous reports mainly from Africa. In our cohort of patients we cannot confirm risk factors like lower CD4-cellcount, higher viral load, younger age or male gender. Despite the hypothesis, that a predominance of pro-inflammatory immune response may be the mechanism underlying IRIS, prophylactic corticosteroids had no preventative effect in our subgroup of patients.