| Objective To determine the incidence, clinical manifestation,risk factors and part of lymphokines in the role of the immune mechanism for IRIS in patients initiating HAART.Methods A prospective study of all patients initiating HAART between June 2006 to May 2009 in the first hospital of ChangSha was performed. A period of six months tracking initiating HAART. According to the unified standards diagnosised who happend IRIS or not. Analysed the incidence of IRIS, time of occurrence, clinical disease spectrum. To find the risk factors for IRIS by multiple logistic regression analysis, compared general information before HAART in IRIS group and non-IRIS group, including sexulity, age, clinical staging, how mang infections and which type infections, the degree of infections be controlled (instead of the degree of fever be controlled), HAART regimen, CD4+ and HIVRNA level before HAART, CD4+ growth and HIVRNA decrease initiating HAART. Examined the main T lymphokines:IL-2, INF-γ, IL-4, IL-10 which on behalf of the balance.of Thl and Th2. To explore the immune mechanisms for IRIS, the levels which at pre-HAART, initiating HAART 1 month,3 months and 6 months were compared in IRIS group and non-IRIS group,healthy group.Results A total of 212 patients were included, of whom 131 were male,81 were female. The median baseline CD4+ cell and HIVRNA load were 64 cell/μl and 5.081og10 copies/ml. There were 59(27.8%) patients experienced an IRIS event at a median of 21 days after HAART initiation (Qr 19 days after initiation); According to the frequency of occurrence from high to low, the disease spectrum included tuberculosis (including pulmonary tuberculosis, lymphatic tuberculosis, tuberculosis peritonitis), herpes virus infections (including genital herpes, herpes simplex, herpes zoster), pneumocystis jirovecii pneumonia, cryptococcal meningitis, Penicillium marneffei infection, cytomegalovirus infection, cirrhosis,mycobacterium avium complex disease, disseminated histoplasmosis, autoimmune hepatitis. Risk factors of IRIS included foundation infection quantity (OR= 1.655), degree of infection be controlled (OR=2.344), CD4+ baseline before HAART (OR= 1.556). No matter in the IRIS group or in the non-IRIS group, IL-2, INF-γand IL-4, IL-10, the main lymphokines baseline representing the balance relations of Th1 and Th2 compared to healthy group separately reduced and increased before HAART(p<0.05), which gradually had the tendency to restore balance relations initiating HAART. The lymphokines levels were significance difference between baseline and 6 months initiating HAART(p<0.05). The lymphokines changed levels compared to healthy group between IRIS group and non-IRIS group before HAART were significance difference. IL-2, INF-γincreased level and IL-10 decreased level were significance difference between IRIS group and non-IRIS group intiating HAART 1 month(p<0.05). the decreased level of IL-4 in the same period had no significant difference (p>0.05).Conclusions Those phenomenon be found in this study.1.The incidence of IRIS during 6 months initiating HAART in HIV/AIDS was 27.8%, mortality rate was 3.39%, IRIS occurred a median time in 1 month initiating HAART. The most common disease spectrum was tuberculosis, herpes virus infection.2. The strongest independent predictors of IRIS were how much of the underlying infections, the degree of fever be controlled and the CD4+ baseline before HAART. The more antigens burdent and the lower CD4+ baseline, the more IRIS happened. Sexulity, age, route of transmission, HAART project, the baseline of HIVRNA level and rate of decline, CD4+ growth rates didn't find relationship.3. Lymphokine of Th1 and Th2 existed unbalance in IRIS group and non-IRIS group before HAART. the unbalance tendency in IRIS group was more obvious. All lymphokines had the trend to recover balance. IL-2, INF-y increase significant and IL-10 decrease significant may be involved in the occurrence of the IRIS. |
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