| Background and Objection:To the end of September 2013, China CDC reported nearly 434,000 cases of AIDS or HIV infected while receiving antiretroviral treatment to more than 26000 cases.HAART (highly active antiretroviral therapy) that is saving thousands of lives is widely used in AIDS patients since 1996. After initiating therapy a paradoxical clinical worsening of a known condition or the new appearance sometimes characterizes the syndrome that even causes the patients’ death. It is manifested by the increasing CD4+ T-lymphocyte counts and decreases in plasma HIV-1 viral loads of a result of partial recovery of immune system but the clinical deterioration occurs during immune recovery. This phenomenon has been described as immune restoration disease (IRD), immune reconstitution syndrome (IRS) or immune reconstitution inflammatory syndrome (IRIS). In china there are few discussions about the systemic imaging changes of IRIS patients. The overall incidence of IRIS is about 10%-30% and it is dependent on the population studied and its underlying opportunistic infectious burden. The infectious pathogen most frequently is the mycobacterium tuberculosis, so we are trying to figure out the specific radiology, the clinical and the laboratory characters of the IRIS patients infected with the mycobacterium tuberculosis in Shanghai of China.Method:A prospective study of patients initiating HAART or ART with tuberculosis infected during September 2004—September 2013 in Shanghai Public Health Clinical Center. With the help of clinical patients we diagnose the patients whether happened IRIS or not. Comparing the images, the clinical manifestation and the laboratory data of the non-IRIS group with the IRIS group and we discuss the imaging characters of the IRIS group. There are two attending physicians to analyze the images. We process data of stata 10.0, two sets of data between a statistically significant difference (P<0.05)Result:There are 51 patients included, of whom 33 were male and 18 were female. The age is about (33.63±7.32) years. Before the HAART there are 11 patients infected with tuberculosis.14 patients are involved in central nervous system,41 patients are infected in respiratory system and 6 patients are involved cervical lymph nodes or psoas major. The average CD4 cell counts are about 80.67±95.34/ul before the HARRT. The rise counts of CD4 cells are about 406.25±149.27/ul after the HAART. The patients experienced CNS-IRIS event about 84.07±16.52 days and respiratory system IRIS about 37.92± 10.67 days after HAART initiation. There are 24 patients with dizziness or headache,41 patients with expectoration or cough or dyspnea, and 5 patients with bellyache or soft tissue pain.6 patients of CNS-IRIS are died.There are 183 patients included in the non-IRIS group with mycobacterium tuberculosis infected, of whom 112 were male and 71 were female, the age is about (40.67±10.93) years.36 patients are involved in CNS,147 patients are infected in respiratory system. The average CD4 cell counts are about 110±120.34/ul before the HAART. The rise counts of CD4 cells are about 327.38±110.65/ul after the HAART. There are 68 patients with dizziness or headache,132 patients with expectoration or cough or dyspnea.1、Central nervous system:(1) The main imaging features of AIDS patients with tuberculosis: ①meningeal reinforcement; ②single or multiple tuberculoma;③edema;④hydrocephalus;⑤ tuberculous abscesses.(2)Comparing the images between the IRIS group and non-IRIS group:No statistical difference in meningeal reinforcement, tuberculoma enhancement, mass effect and the other imaging findings.(3) Comparing the images between of IRIS group with the baseline images, meningeal reinforcement,lesions enhancement and mass effect are of statistically significant (P<0.05)Respiratory system infectious:(1)The main imaging features of AIDS patients with tuberculosis:①miliary tuberculosis;②pulmonary nodules and plaques;③consolidation;④ivolved in more pulmonary lobes;⑤mediastinal lymph node enlargement, necrosis or mediastinal lymph node enlargement mixed together;⑥pericardial effusion or pleural effusion.(2) Comparing the images between the IRIS group and non-IRIS group: The ratio of the pericardial effusion、the military tuberculosis and the change of mediastinal lymph are of statistically significant(P<0.05).(3) Comparing the images between of IRIS group with the baseline images: The patients develop into IRIS of the appearance of the new lesions or the progressing pre-lesion.3、Other systems Other systems IRIS are always accompanied with respiratory system and there are no specific imaging changes.Conclusion:1、Most patients of AIDS of HIV infected experienced IRIS are always young and middle ages especially males. Before the HAART the count of CD4 are<50/ul of 60% patients. The average days of occurring IRIS are within three months. The average days of occurring CNS-IRIS are twice times of other system.2、There are no statistic differences between the IRIS group and the non-IRIS group in central nervous system. IRIS group is easy to appear military tuberculosis, the change of mediastinal lymph and pericardial effusion of respiratory system. Other systems IRIS are always accompanied with respiratory system and there are no specific imaging changes3、The new lesions or lesions evolving by comparing with baseline images after HAART and sticking to HAART and antituberculosis therapy the patients recovering are of specificity. |
PDF Full Text Request