Risk factors for the development of immune reconstitution inflammatory syndrome in HIV-positive patients

Objectives: Immune reconstitution inflamatory syndrome (IRIS), which occurs especially in the first 6 months, with the initiation of antiretroviral therapy (ART) in individuals infected with human immunodeficiency virüs (HIV) and developing Acquired Immune Deficiency Sydrome (AIDS). Clinical presentations of IRIS; Mycobacterium avium komplex lympadenitis, pneumonia caused by Mycobacterium tuberculosis and paradoxical exacerbations of central nervous system infection, Cryptococcus neoformans meningitis and paradoxical exacerbations of cytomegalaovirus uveitis. Clinician, HIV-infected patients occasionally hesitate to develop IRIS when starting ART and has difficulty predicting. In this thesis; risk factors for the development of IRIS were evaluated by looking at age, gender, baseline CD4+ count, initial viral load, substance use history, presence of diabetes mellitus and Purified Protein Derivative of Tuberculin (PPD) numerical value. Thus, it was aimed to strenghten the predictability of which patient would be at high risk when starting ART. Materials and Methods: Our study included all patients aged 18 years and older who applied to Dicle University Medical Faculty Hospital, Infectious Diseases and Clinical Microbiology Clinic and Polylinic between 1 January 2010 and 1 October 2021, were diagnosed with HIV/AIDS and were followed up at least once. The data of 204 patients included in the study were obtained by scanning the hospital information system. At the time of diagnosis of the patients; age, gender, baseline CD4+ count, baseline viral load, substance abuse history, diabetes mellitus, PPD numeric value and HIV RNA CD4+ counts in the 1st and 3rd months of the treatment were examined again and it was tried to determine how effective these factors were in the development of IRIS in the 3 months period. Results: The IRIS clinic was examined in the patient groups that developed and did not develop; age (p=0,793), gender (p=0,419), substance use history (p=0,838), presence of diabetes mellitus (p=0,326), PPD numerical value (p=0,501) and CD4+ value at 3 months (p=0,302) no statistical significance was found. HIV RNA count at baseline, 1st month and 3rd month (p=0,001) and CD4+ count at baseline (p=0,009) and 1st month (p=0,018) were found statistically significant in terms of IRIS development.. Conclusions: The HIV RNA level that clinician looks at before ART, at the 1st and 3rd months of treatment and the CD4+ count before ART and at the 1st mont hare important parameters in predicting the development of IRIS, our study is important because there are few similar studies in the literature on the determination of risk factors in various IRIS infections.