Paradoxical immune reconstitution inflammatory syndrome associated with cryptococcal meningitis in China: a 5-year retrospective cohort study

S Yan; L Chen; W Wu; Z Li; Z Fu; H Zhang; J Xue; Y Hu; J Mou; C Fu

doi:10.1016/j.cmi.2014.11.011

Paradoxical immune reconstitution inflammatory syndrome associated with cryptococcal meningitis in China: a 5-year retrospective cohort study

Clin Microbiol Infect. 2015 Apr;21(4):379.e11-4. doi: 10.1016/j.cmi.2014.11.011. Epub 2014 Nov 20.

Authors

S Yan¹, L Chen², W Wu³, Z Li¹, Z Fu⁴, H Zhang⁵, J Xue¹, Y Hu³, J Mou⁶, C Fu⁷

Affiliations

¹ Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China.
² Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China. Electronic address: [email protected].
³ Hunan Provincial Tumor Hospital, Changsha, China.
⁴ Centers for Disease Control and Prevention of Hunan Province, China.
⁵ Centers for Disease Control and Prevention of Changsha City, Hunan Province, China.
⁶ Changsha Medical University, Hunan Province, China.
⁷ Xiangya Hospital, Central South University, Changsha, Hunan Province, China.

PMID: 25658526
DOI: 10.1016/j.cmi.2014.11.011

Abstract

We performed a retrospective cohort study of hospitalised cryptococcal meningitis (CM) patients at a single centre to evaluate the clinical epidemiological features of paradoxical cryptococcal-related immune reconstitution inflammatory syndrome (CM-IRIS) in a setting in China. A total of 154 AIDS patients with CM were involved, and 17.5% experienced IRIS at a median of 27 days after initiation of antiretroviral therapy (ART). Overall, 3 deaths were directly attributed to IRIS. The occurrences of CM-IRIS were independently associated with the pre-ART CD4+count, pre-C-reactive protein level, and the timing of ART initiation.

Keywords: ART; HIV/AIDS; IRIS; cryptococcal meningitis; predictors.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Retroviral Agents / administration & dosage*
C-Reactive Protein / analysis
CD4 Lymphocyte Count
China / epidemiology
Female
HIV Infections / complications*
HIV Infections / drug therapy*
Hospitals
Humans
Immune Reconstitution Inflammatory Syndrome / diagnosis*
Immune Reconstitution Inflammatory Syndrome / epidemiology
Immune Reconstitution Inflammatory Syndrome / mortality
Immune Reconstitution Inflammatory Syndrome / pathology*
Male
Meningitis, Cryptococcal / complications*
Middle Aged
Retrospective Studies
Survival Analysis
Young Adult

Substances

Anti-Retroviral Agents
C-Reactive Protein