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AN INFLAMMATORY COMPOSITE SCORE PREDICTS MYCOBACTERIAL IRIS IN PEOPLE WITH HIV AND SEVERE LYMPHOPENIA: A PROSPECTIVE INTERNATIONAL COHORT STUDY
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Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Faculdade de Tecnologia e Ciências. Curso de Medicina. Salvador, BA, Brazil.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Faculdade de Tecnologia e Ciências. Curso de Medicina. Salvador, BA, Brazil.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brazil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil
Kenya Medical Research Institute. United States Army Medical Research Directorate-Kenya. Henry Jackson Foundation Medical Research International. Quênia, Nairobi.
Kenya Medical Research Institute. United States Army Medical Research Directorate-Kenya. Henry Jackson Foundation Medical Research International. Quênia, Nairobi.
South East Asia Research Collaboration with Hawaii Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program. Bethesda, Maryland.
Thai Red Cross AIDS Research Centre. Bangkok, Thailand.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Faculdade de Tecnologia e Ciências. Curso de Medicina. Salvador, BA, Brazil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brazil / Universidade Salvador. Laureate Universities. Salvador, BA, Brazil / University of Cape Town. Institute of Infectious Disease and Molecular Medicine. Wellcome Centre for Infectious Disease Research in Africa. Cape Town, South Africa.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Faculdade de Tecnologia e Ciências. Curso de Medicina. Salvador, BA, Brazil.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brazil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil
Kenya Medical Research Institute. United States Army Medical Research Directorate-Kenya. Henry Jackson Foundation Medical Research International. Quênia, Nairobi.
Kenya Medical Research Institute. United States Army Medical Research Directorate-Kenya. Henry Jackson Foundation Medical Research International. Quênia, Nairobi.
South East Asia Research Collaboration with Hawaii Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program. Bethesda, Maryland.
Thai Red Cross AIDS Research Centre. Bangkok, Thailand.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Faculdade de Tecnologia e Ciências. Curso de Medicina. Salvador, BA, Brazil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brazil / Universidade Salvador. Laureate Universities. Salvador, BA, Brazil / University of Cape Town. Institute of Infectious Disease and Molecular Medicine. Wellcome Centre for Infectious Disease Research in Africa. Cape Town, South Africa.
National Institutes of Health. National Institutes of Allergy and Infectious Diseases. Bethesda, Maryland, USA.
Abstract
Background: Immune reconstitution inflammatory syndrome (IRIS) is a common cause of morbidity among people with HIV (PWH) who initiate ART with severe lymphopenia. Easily accessible tools that reliably predict emergence and elucidate pathogenesis of IRIS are needed to facilitate improved clinical management. Methods: Plasma levels of biomarkers were measured before ART initiation in a large multinational cohort of antiretroviral therapy (ART)-naïve PWH with severe immunosuppression (CD4+ count <100 cells/mm³) in US, Kenya and Thailand (NCT00286767). We performed a series of multiparametric analyses of inflammatory and clinical biomarkers and developed a composite score merging relevant biomarkers for use in a prediction model. Results: We identified a distinct baseline inflammatory profile and changes in inflammatory networks among biomarkers in participants who subsequently developed mycobacterial or viral IRIS. We also developed a composite score incorporating biomarkers associated with IRIS (IL-6, IL-10, IL-27, sCD14, IFN-γ, TNF-α, hyaluronic acid, D-dimer, body mass index and hemoglobin) that accurately predicted mycobacterial IRIS and death in this cohort. Conclusions: Systemic inflammatory profiles in PWH with severe immunosuppression are predictive of IRIS. Composite scores for the prediction of mycobacterial IRIS and death could be useful for risk stratification in PWH and lymphopenia initiating ART.
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