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Paradoxical immune reconstitution inflammatory syndrome associated with cryptococcal meningitis in China: a 5-year
1Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China.
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.
Insights
Paradoxical cryptococcal meningitis-immune reconstitution inflammatory syndrome (CM-IRIS) occurred in 17.5% of hospitalized AIDS patients in China. Key risk factors included pre-treatment CD4+ count, C-reactive protein levels, and antiretroviral therapy timing.
Area of Science:
- Infectious Diseases
- Immunology
- Epidemiology
Background:
- Cryptococcal meningitis (CM) is a significant opportunistic infection in individuals with advanced HIV/AIDS.
- Immune reconstitution inflammatory syndrome (IRIS) can complicate antiretroviral therapy (ART) initiation in these patients.
- Paradoxical CM-IRIS presents a specific challenge in managing HIV-associated neuroinfections.
Purpose of the Study:
- To investigate the clinical and epidemiological characteristics of paradoxical CM-IRIS.
- To identify risk factors associated with the development of CM-IRIS in hospitalized patients in China.
- To understand the impact of CM-IRIS on patient outcomes.
Main Methods:
- Retrospective cohort study design.
- Inclusion of 154 hospitalized patients diagnosed with CM and AIDS.
- Analysis of clinical data, including CD4+ T-cell counts, C-reactive protein levels, and ART initiation timing.
Main Results:
- 17.5% of patients developed CM-IRIS at a median of 27 days post-ART initiation.
- Three deaths were directly attributed to CM-IRIS.
- Independent risk factors for CM-IRIS included lower pre-ART CD4+ count, elevated pre-ART C-reactive protein, and the timing of ART initiation.
Conclusions:
- Paradoxical CM-IRIS is a notable complication in hospitalized AIDS patients with CM in China.
- Specific immunological and clinical markers predict CM-IRIS development.
- Timely identification and management of risk factors are crucial for improving outcomes in CM-IRIS patients.
