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Incidence and Predictors of Immune Reconstitution Inflammatory Syndrome in a Rural Area of Mozambique

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Listed:
  • Emilio Letang
  • José M Miró
  • Tacilta Nhampossa
  • Edgar Ayala
  • Joaquim Gascon
  • Clara Menéndez
  • Pedro L Alonso
  • Denise Naniche

Abstract

Background: There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique. Methods: One hundred and thirty-six consecutive antiretroviral treatment (ART)-naïve HIV-1-infected patients initiating ART at the Manhiça district hospital were prospectively followed for development of IRIS over 16 months. Survival analysis by Cox regression was performed to identify pre-ART predictors of IRIS development. Results: Thirty-six patients developed IRIS [26.5%, incidence rate 3.1 cases/100 persons-month of ART (95% CI 2.2–4.3)]. Median time to IRIS onset was 62 days from ART initiation (IQR 35.5–93.5). Twenty-five cases (69.4%) were “unmasking”, 10 (27.8%) were “paradoxical”, and 1 (2.8%) developed a paradoxical worsening followed by the unmasking of another condition. Systemic OI (OI-IRIS) accounted for 47% (17/36) of IRIS cases, predominantly of KS (8 cases) and TB (6 cases) IRIS. Mucocutaneous IRIS manifestations (MC-IRIS) accounted for 53% (19/36) of IRIS events, mostly tinea (9 cases) and herpes simplex infection (3 cases). Multivariate analysis identified two independent predictors of IRIS development: pre-ART CD4 count

Suggested Citation

  • Emilio Letang & José M Miró & Tacilta Nhampossa & Edgar Ayala & Joaquim Gascon & Clara Menéndez & Pedro L Alonso & Denise Naniche, 2011. "Incidence and Predictors of Immune Reconstitution Inflammatory Syndrome in a Rural Area of Mozambique," PLOS ONE, Public Library of Science, vol. 6(2), pages 1-9, February.
    • Handle: RePEc:plo:pone00:0016946
    DOI: 10.1371/journal.pone.0016946
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