1 / 23

The study of immune reconstitution inflammatory syndrome(IRIS) in resource limited settings

The study of immune reconstitution inflammatory syndrome(IRIS) in resource limited settings. Dr Milind Bhrushundi M D Dr Pradeep Mishra M D Lata Mangeshkar Hospital Nagpur India. Objectives.

charles-carney
Download Presentation

The study of immune reconstitution inflammatory syndrome(IRIS) in resource limited settings

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The study of immune reconstitution inflammatory syndrome(IRIS) in resource limited settings Dr Milind Bhrushundi M D Dr Pradeep Mishra M D Lata Mangeshkar Hospital Nagpur India

  2. Objectives • To assess proportion of patients developing IRIS after initiation of antiretroviral therapy attending Lata Mangeshkar Hospital (LMH) in Nagpur, India • To describe pattern of IRIS • To identify factors associated with development of IRIS

  3. Methods • 720 consecutive patients attending LMH, Nagpur between 2002- 2005 were recruited • Patients were examined clinically & investigated for presence of OI before initiating ART & treated wherever necessary • Since patients had to pay for complete/ part of tests, package of investigations differed.

  4. Investigations

  5. Case definition • Appearance of new OI or deterioration in patients treated for OI who showed signs & symptoms of clinical improvement initially within 3 months of initiating ART with increase in CD4+ counts • Worsening of the symptoms without significant rise in CD4+ T-helper were excluded by the definition .

  6. Demographic profile n=720 • Age- Mean- 35.6 years ( range; 21-75 yrs) • Sex- 582 Males and 138 females • Baseline Investigations: Essential – 230 (32%); Optional -366 (51%), Ideal - 124 (17%) • Of them, 549 (76%) were ARV-naïve. • Of the 171 ARV-experienced patients, 26 (17%) had received two ARVs & 143 (83%) received 3 ARVs • Of the ARV-naïve patients, 71 ( 13%) received EFV-based regime & remaining received NVP-based regimen.

  7. Results • Univariate analysis revealed • IRIS was not associated with any age group (p=0.06) • However, females were found to be less likely to develop IRIS (p=0.001) • Patients who were offered essential (minimal tests) package at baseline were more likely to develop IRIS (p= 0.001)

  8. Results • Patients with CD4 < 50 cells & between 50-100 cells/cm were likely to develop IRIS (p=0.0001) • Patients with past history or current OI were more likely to develop IRIS (p=0.0001) • Patients with CD4 counts of <50 cells were 40 times more likely to develop IRIS. (p= .0001),CD4 counts of <100 cells were 12 times more likely to develop IRIS. (p= 0.0001)

  9. Results • Multivariate analysis revealed that the likelihood of development of IRIS was; • Males were 3.1 ( 95% CI – 0.92-11.1) times more likely to develop IRIS than females. (P=0.06) • Patients with CD4 counts of <50 cells were 4.3 times more likely to develop IRIS. (p= 0.0001) • Those who could only afford a minimal (essential) package of base line laboratory tests were 1.4 times more likely to develop IRIS (p=0.05)

  10. Patterns of IRIS

  11. Patterns of TB IRIS

  12. DIAGNOSIS OF IRIS CASES PRIOR TO ART

  13. CORRELATION OF AKT REGIMEN

  14. Treatment of IRIS • TB-DOTS,NVP changed to EFV • PCP- TMP/SMX, Steroids used in 3 cases, one mortality • Cryptococcal Meningitis-Amphotericin-B, one mortality, two had Amphotericin toxicity • CMV retinitis- Rx not affordable-Optic Atrophy, otherwise normal. • Hepatitis C- Pegylated interferon+ Ribavarin • PML-ART, Still having neurological symptoms

  15. FOLLOW-UP IRIS CASES Mortality

  16. Conclusions • IRIS occurred in 9.4% patients initiated on ART in Nagpur India • All those who have developed IRIS had prior history of OI • Limited investigations prior to initiation of ART is associated with increased risk of IRIS • Proportion of IRIS is less in Government run free ART clinic because of strict protocol for the investigation prior to ART .

  17. Conclusion • Proportion of cases is significantly high with low baseline CD4+ counts(<50) • % increase in CD4+ cells was significantly high (192%) with low CD4+ • Tuberculosis continues to predominate in IRIS in India (in 54% cases) • Need to educate the Physicians for proper ART(16.66% were on double drug therapy)

  18. Thanks • Dr R R Gangakhedkar • Dr Suresh Ughade • Dr Urmila Varadpande • All My patients • My wife and daughter • Sanjeevan – Nagpur- India

More Related