Immune Reconstitution Inflammatory Syndrome in Patients with Human Immunodeficiency Virus Infection: A Multicenter BUHASDER Study

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Köse Ş.

Mediterranean Journal of Infection, Microbes and Antimicrobials, cilt.15, sa.1, ss.234-244, 2026 (ESCI, Scopus, TRDizin)

Özet

Introduction: The advent of effective antiretroviral therapy (ART) has markedly improved the survival and quality of life of people living with human immunodeficiency virus (HIV). Nevertheless, the rapid restoration of immune function following ART initiation can precipitate immune reconstitution inflammatory syndrome (IRIS), a condition that may lead to clinical deterioration. This study aimed to characterize the clinical features, therapeutic approaches, and outcomes of patients with HIV infection who developed IRIS. Materials and Methods: This retrospective multicenter study included 13 centers. Data from 31 patients with HIV infection diagnosed with immune IRIS were collected from electronic medical records and analyzed. Demographic characteristics, immunologic and virologic status at ART initiation, IRIS type, associated opportunistic infections, treatment strategies, and clinical outcomes were evaluated. In addition, the clinical and laboratory characteristics of survivors (n = 26) and non-survivors (n = 5) were compared. A p value < 0.05 was considered statistically significant. Results: The mean age of patients at ART initiation was 42.74 ± 12 years (median, 43 years; range, 18-61 years). Twenty-one patients (67.7%) developed paradoxical IRIS, whereas 10 (32.3%) developed unmasking IRIS. The most common OIs were Mycobacterium tuberculosis, Pneumocystis jirovecii, and cytomegalovirus disease. At ART initiation, 71% of patients had a CD4+ T-cell count < 100 cells/mm3, and 74% had an HIV RNA level >100,000 IU/ mL. In the exploratory mortality analysis, central nervous system (CNS) involvement (p = 0.001), progressive multifocal leukoencephalopathy (PML) (p = 0.012), lymphoma (p = 0.020), meningismus (p = 0.048), and worsening cerebrospinal fluid findings (p = 0.012) were more frequently observed among non-survivors, as was a higher baseline lymphocyte count at ART initiation (median, 1,640 vs. 870 cells/mm3; p = 0.036). Conclusion: Most patients who developed IRIS had advanced immunosuppression and a high baseline viral load at ART initiation. CNS involvement and PML were more frequently observed among non-survivors; however, given the small number of deaths, these findings are hypothesis-generating and require confirmation in larger multicenter studies.