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. 2023 Aug 10:10:1192086.
doi: 10.3389/fmed.2023.1192086. eCollection 2023.

Immune reconstitution inflammatory syndrome, a controversial burden in the East African context: a systematic review and meta-analysis

Alene Geteneh #  1 , Henok Andualem #  2 , Demeke Mesfin Belay  3 , Mulugeta Kiros  4 , Sirak Biset  5
Affiliations

Immune reconstitution inflammatory syndrome, a controversial burden in the East African context: a systematic review and meta-analysis

Alene Geteneh et al. Front Med (Lausanne). .

Abstract

Introduction: It is well established that starting antiretroviral therapy (ART) increases a patient's life expectancy among HIV-positive individuals. Considering the HIV pandemic, the major concern is initiation of ARTs to the large segment of HIV infected population, not adverse events from immune restoration. The prevalence of HIV-associated immune reconstitution inflammatory syndrome (IRIS) is poorly estimated due to Africa's underdeveloped infrastructure, particularly in Eastern Africa. Therefore, this study compiled data regarding the magnitude and associated factors of IRIS in the context of Eastern Africa.

Methods: The electronic databases such as Google Scholar, PubMed, Web of Science, and free Google access were searched till 5 June 2021, and the search was lastly updated on 30 June 2022 for studies of interest. The pooled prevalence, and associated factors with a 95% confidence interval were estimated using the random effects model. The I2 and Egger's tests were used for heterogeneity and publication bias assessment, respectively.

Results: The development of HIV-associated IRIS in Eastern Africa was estimated to be 18.18% (95% CI 13.30-23.06) in the current review. The two most common predictors of IRIS associated with Eastern Africa were the lower pre-ART CD4 T-cell count of 50 cells/μl and the low baseline body mass index level. Therefore, attention should be focused on the early detection and care of HIV-associated IRIS to reduce the morbidity and death caused by IRIS.

Keywords: ART; East Africa; HIV; HIV-associated IRIS; IRIS.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Forest plot of the prevalence of IRIS among HIV patients.
Figure 3
Figure 3
Publication bias, Funnel plots show the presence of publication bias (A), and trim and fill analysis was used to resolve the bias (B).
Figure 4
Figure 4
Sensitivity analysis presenting the influence of single study on the overall prevalence of IRIS among HIV-infected individuals.
Figure 5
Figure 5
Sub-group analysis by the country of study on the prevalence of IRIS in HIV patients.
Figure 6
Figure 6
The pooled odds of IRIS among BMI < 18.5 kg/m3 (A); and the lower pre-ART CD4 count patients in East Africa (B).
See this image and copyright information in PMC

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