This Article Full Text (PDF) All Versions of this Article: 1545109709332469v1 8/2/122    most recent References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Klotz, S. A. Articles by Handrich, M. Search for Related Content PubMed PubMed Citation Articles by Klotz, S. A. Articles by Handrich, M. Social Bookmarking                         What's this?

Immune Reconstitution Inflammatory Syndrome in a Resource-Poor Setting

Section of Infectious Diseases, School of Health Sciences, University of Arizona, Tucson, Arizona, sklotz{at}u.arizona.edu, International Center for Equal Healthcare Access, New York, New York

Abdul Aziz Mohammed, MD

Dessie Referral Hospital, South Wollo, Dessie, Ethiopia

Mulugeta Girmai Woldemichael, MD

Dessie Referral Hospital, South Wollo, Dessie, Ethiopia

Mongistu Worku Mitku, MD

Dessie Referral Hospital, South Wollo, Dessie, Ethiopia

Mitchell Handrich, RN

International Center for Equal Healthcare Access, New York, New York, Charity Hospital, New Orleans, Louisiana

The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm³. Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.

Key Words: IRIS • AIDS • Ethiopia • Africa • gastroenteritis

This version was published on March 1, 2009

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 8, No. 2, 122-127 (2009)
DOI: 10.1177/1545109709332469


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?