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Meta-Analysis
. 2010 Apr;10(4):251-61.
doi: 10.1016/S1473-3099(10)70026-8.

Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis

Monika Müller  1 , Simon Wandel, Robert Colebunders, Suzanna Attia, Hansjakob Furrer, Matthias Egger; IeDEA Southern and Central Africa
Affiliations
Meta-Analysis

Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis

Monika Müller et al. Lancet Infect Dis. 2010 Apr.

Abstract

In patients with HIV-1 infection who are starting combination antiretroviral therapy (ART), the incidence of immune reconstitution inflammatory syndrome (IRIS) is not well defined. We did a meta-analysis to establish the incidence and lethality of the syndrome in patients with a range of previously diagnosed opportunistic infections, and examined the relation between occurrence and the degree of immunodeficiency. Systematic review identified 54 cohort studies of 13 103 patients starting ART, of whom 1699 developed IRIS. We calculated pooled cumulative incidences with 95% credibility intervals (CrI) by Bayesian methods and did a random-effects metaregression to analyse the relation between CD4 cell count and incidence of IRIS. In patients with previously diagnosed AIDS-defining illnesses, IRIS developed in 37.7% (95% CrI 26.6-49.4) of those with cytomegalovirus retinitis, 19.5% (6.7-44.8) of those with cryptococcal meningitis, 15.7% (9.7-24.5) of those with tuberculosis, 16.7% (2.3-50.7) of those with progressive multifocal leukoencephalopathy, and 6.4% (1.2-24.7) of those with Kaposi's sarcoma, and 12.2% (6.8-19.6) of those with herpes zoster. 16.1% (11.1-22.9) of unselected patients starting ART developed any type of IRIS. 4.5% (2.1-8.6) of patients with any type of IRIS died, 3.2% (0.7-9.2) of those with tuberculosis-associated IRIS died, and 20.8% (5.0-52.7) of those with cryptococcal meningitis died. Metaregression analyses showed that the risk of IRIS is associated with CD4 cell count at the start of ART, with a high risk in patients with fewer than 50 cells per microL. Occurrence of IRIS might therefore be reduced by initiation of ART before immunodeficiency becomes advanced.

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Conflict of interest statement

Conflict of interest

All authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Identification of eligible cohort studies of HIV-infected patients starting antiretroviral therapy.
Figure 2
Figure 2. Meta-analysis of 54 cohort studies of the incidence of immune reconstitution disease (IRD) in HIV-infected patients starting antiretroviral therapy
Estimates of incidences in percent from individual studies with 95% confidence intervals (95% CI) and combined estimates with 95% credibility intervals (95% CrI) are shown.
Figure 3
Figure 3. Incidence of immune reconstitution disease (IRD) in 22 cohort studies according to median CD4 count at the start of antiretroviral therapy
The solid line shows the predicted percentage from the meta-regression model, the dotted lines indicate the 95% confidence intervals. The size of circles is proportional to the weight in the random-effect model.
See this image and copyright information in PMC

Comment in

  • Immune reconstitution inflammatory syndrome.
    Lawn SD, Wood R. Lawn SD, et al. Lancet Infect Dis. 2010 Dec;10(12):833-4. doi: 10.1016/S1473-3099(10)70280-2. Lancet Infect Dis. 2010. PMID: 21109173 Free PMC article. No abstract available.

References

    1. Sterne JA, Hernan MA, Ledergerber B, Tilling K, Weber R, Sendi P, et al. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. Lancet. 2005;366(9483):378–84. - PubMed
    1. Autran B, Carcelain G, Li TS, Blanc C, Mathez D, Tubiana R, et al. Positive effects of combined antiretroviral therapy on CD4+ T cell homeostasis and function in advanced HIV disease. Science. 1997;277(5322):112–6. - PubMed
    1. Battegay M, Nuesch R, Hirschel B, Kaufmann GR. Immunological recovery and antiretroviral therapy in HIV-1 infection. Lancet Infect Dis. 2006;6(5):280–7. - PubMed
    1. Organization WH. 2009 Progress Report. Geneva: World Health Organization; 2009. Towards universal access. Scaling up priority HIV/AIDS interventions in the health sector.
    1. Braitstein P, Brinkhof MW, Dabis F, Schechter M, Boulle A, Miotti P, et al. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet. 2006;367(9513):817–24. - PubMed

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