Impact of the immune reconstitution inflammatory syndrome (IRIS) on mortality and morbidity in HIV-infected patients in Mexico

Int J Infect Dis. 2011 Jun;15(6):e408-14. doi: 10.1016/j.ijid.2011.02.007. Epub 2011 Apr 13.


Objectives: To estimate the impact of immune reconstitution inflammatory syndrome (IRIS) on morbidity and mortality in patients starting highly-active antiretroviral therapy (HAART).

Methods: A retrospective cohort study of HIV-positive patients starting HAART was conducted at a tertiary care referral center in Mexico City. We estimated the incidence of IRIS, hospitalizations and death rates during the first 2 years of HAART. The relative risk of death (RR) and hospitalization for patients with IRIS were adjusted for relevant covariates using regression methods.

Results: During the 2-year follow-up period, 27% of patients developed IRIS (14 IRIS cases per 100 person-years). The relative risk of death among patients who developed IRIS was 3 times higher (95% confidence interval (CI) 1.19-7.65, p = 0.03). After adjusting for previous opportunistic infections we still observed a higher death rate among patients with IRIS (RR 2.3, 95% CI 0.9-5.9, p=0.09). An effect modification of IRIS over mortality was observed by previous opportunistic infection.

Conclusions: IRIS-associated mortality is strongly confounded by previous opportunistic infection. Patients with AIDS who eventually developed IRIS had the highest risk of death at the 2-year follow-up.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / etiology
  • AIDS-Related Opportunistic Infections / immunology
  • Adult
  • Antiretroviral Therapy, Highly Active / methods*
  • Cohort Studies
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / mortality*
  • HIV-1 / immunology
  • Hospitalization / statistics & numerical data*
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / epidemiology*
  • Immune Reconstitution Inflammatory Syndrome / etiology
  • Immune Reconstitution Inflammatory Syndrome / immunology
  • Incidence
  • Male
  • Mexico / epidemiology
  • Morbidity
  • Retrospective Studies
  • Risk Factors