Clinical and immunologic predictors of Mycobacterium avium complex immune reconstitution inflammatory syndrome in a contemporary cohort of patients with HIV

National Institutes of Health. National Institute of Allergy and Infectious Diseases. Bethesda, MD, 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, Brasil.
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, Brasil.
National Institutes of Health. National Institute of Allergy and Infectious Diseases. Bethesda, MD, USA.
National Institutes of Health. National Institute of Allergy and Infectious Diseases. Bethesda, MD, USA.
Fredrick National Laboratory for Cancer Research. Leidos Biomedical Research Inc. Frederick, MD, 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, Brasil / Universidade Federal da Bahia. Faculdade de Medicina, Salvador, BA, Brasil / Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil / Universidade Salvador. Laureate Universities. Curso de Medicina. Salvador, BA, Brasil.
National Institutes of Health. National Institute of Allergy and Infectious Diseases. Bethesda, MD, USA.
National Institutes of Health. National Institute of Allergy and Infectious Diseases. Bethesda, MD, USA.

Abstract

Background: Patients with HIV (PWH) can present with new or worsening symptoms associated with Mycobacterium avium complex (MAC) infection shortly after antiretroviral therapy (ART) initiation as MAC immune reconstitution inflammatory syndrome (MAC-IRIS). In this study, we assessed the utility of several laboratory tests as predictors of MAC-IRIS. Methods: PWH with clinical and histologic and/or microbiologic evidence of MAC-IRIS were identified and followed up to 96 weeks post-ART initiation within a prospective study of 206 ART-naïve patients with CD4 <100 cells/μL. Results: Fifteen (7.3%) patients presented with MAC-IRIS within a median interval of 26 days after ART initiation. Patients who developed MAC-IRIS had lower BMI, lower hemoglobin levels, a higher alkaline phosphatase and increased CD38 frequency and MFI on CD8+ T-cells, at the time of ART initiation compared to non-MAC IRIS patients. A decision tree inference model revealed that stratifying patients based on levels of alkaline phosphatase and D-dimer could predict the likelihood of MAC-IRIS. A binary logistic regression demonstrated that higher levels of alkaline phosphatase at baseline were associated with increased risk of MAC-IRIS development. Conclusions: High alkaline phosphatase levels and increased CD8+ T-cell activation with low CD4 counts at ART initiation should warrant suspicion for subsequent development of MAC-IRIS.

Keywords in Portuguese

HIV
MAC
Mycobacterium
ÍRIS
CRP
Dímero
Fosfatase alcalina

Keywords

HIV
MAC
Mycobacterium
IRIS
Biomarker
CRP
D-dimer
Alkaline phosphatase

Publisher

Oxford University Press

Citation

BREGLIO, Kimberly F. et al. Clinical and immunologic predictors of Mycobacterium avium complex immune reconstitution inflammatory syndrome in a contemporary cohort of patients with HIV. Journal of Infectious Diseases, p. 1-26, 2020.

DOI

10.1093/infdis/jiaa669

ISSN

0022-1899

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/44392

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Open access

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