Prospective International Study of Incidence and Predictors of Immune Reconstitution Inflammatory Syndrome and Death in People Living With Human Immunodeficiency Virus and Severe Lymphopenia

Irini Sereti, Virginia Sheikh, Douglas Shaffer, Nittaya Phanuphak, Erin Gabriel, Jing Wang, Martha C. Nason, Gregg Roby, Hellen Ngeno, Fredrick Kirui, Alice Pau, Joann M. Mican, Adam Rupert, Rachel Bishop, Brian Agan, Nitiya Chomchey, Nipat Teeratakulpisarn, Somsit Tansuphaswadikul, Deborah Langat, Josphat KosgeiMartyn French, Jintanat Ananworanich, Fredrick Sawe

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Patients living with human immunodeficiency virus (PLWH) with low CD4 counts are at high risk for immune reconstitution inflammatory syndrome (IRIS) and death at antiretroviral therapy (ART) initiation. METHODS: We investigated the clinical impact of IRIS in PLWH and CD4 counts <100 cells/μL starting ART in an international, prospective study in the United States, Thailand, and Kenya. An independent review committee adjudicated IRIS events. We assessed associations between baseline biomarkers, IRIS, immune recovery at week 48, and death by week 48 with Cox models. RESULTS: We enrolled 506 participants (39.3% were women). Median age was 37 years, and CD4 count was 29 cells/μL. Within 6 months of ART, 97 (19.2%) participants developed IRIS and 31 (6.5%) died. Participants with lower hemoglobin at baseline were at higher IRIS risk (hazard ratio [HR], 1.2; P = .004). IRIS was independently associated with increased risk of death after adjustment for known risk factors (HR, 3.2; P = .031). Being female (P = .004) and having a lower body mass index (BMI; P = .003), higher white blood cell count (P = .005), and higher D-dimer levels (P = .044) were also significantly associated with increased risk of death. Decision-tree analysis identified hemoglobin <8.5 g/dL as predictive of IRIS and C-reactive protein (CRP) >106 μg/mL and BMI <15.6 kg/m2 as predictive of death. CONCLUSIONS: For PLWH with severe immunosuppression initiating ART, baseline low BMI and hemoglobin and high CRP and D-dimer levels may be clinically useful predictors of IRIS and death risk.

Original languageEnglish
Pages (from-to)652-660
Number of pages9
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume71
Issue number3
DOIs
Publication statusPublished - 27 Jul 2020

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