Revista de SIDA e investigación clínica

Biomarkers in Immune Reconstitution Inflammatory Syndrome (IRIS) among People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)

Abstract

Shravan Kumar Mishra, Sundar Khadka, Subhash Dhital, Raj Kumar Mahto and Krishna Das Manandhar

Background: An Immune Reconstitution Inflammatory Syndrome (IRIS) event is a presentation or a paradoxical worsening of a pre-existing infection following initiation of anti-retroviral therapy in the presence of a decreasing viral load and features consistent with an inflammatory process. This study was conducted to find out the significance of different clinical parameters like hemoglobin, albumin, viral load, erythrocyte, body mass index in the people living with HIV/AIDS with IRIS in Nepalese population. Methods: The study was descriptive with control group. The study included patients who experienced IRIS after initiation of highly active antiretroviral therapy (HAART) with control group as patients who were HIV positive without HAART treatment. This study was carried out on 44 HIV infected individual who initiated HAART and then suffered from IRIS and compared with 56 control HIV infected person without IRIS visiting National Public Health Laboratory (NPHL) for routine HIV viral load testing and CD4 count between April and August, 2014. Results: The patients were categorized into highly active antiretroviral therapy (HAART) naïve (n=56) and on HAART with immune reconstitution inflammatory syndrome (IRIS) (n=44). Among 56 individuals naive HAART, viral load <1000 copies/ml was found in 44 individuals, among which 14 were female (34 ± 1.953 years) and 28 were male (39.40 ± 1.290 years) whereas 12 individual had viral RNA>1000 copies/ml among which 02 were female (34.83 ± 2.030 years) and 10 were male (41.34 ± 1.462 years). The comparison of CD4 count between the naïve and patients enrolled for HAART; the risk of having CD4 count <200 cell/mm3 is significantly greater in male than that of female. The BMI ratio of HAART to naïve patients (19.88 ± 0.7290) was lower than that of HAART enrolled patients (21.78 ± 0.3546). The hemoglobin value showed significant (P value<0.0001) difference among PLHIV having CD4 level less than 200 (9.9 ± 2.156), between 200-500 (11.63 ± 1.946) and more than 500 CD4 level (12.71 ± 1.850). Significant (P<0.0001) viral load suppression showed among HAART initiated female patients with IRIS when compared with naïve female patients without IRIS. BMI, hemoglobin level, total leukocyte count, albumin level, HDL level, ESR value, CRP level and absolute eosinophil level less than 351 cells/mm3 showed significant (P<0.05) difference among HAART naïve and on HAART female patients with IRIS. Significant (P<0.0001) viral load suppression showed among HAART initiated male patients with IRIS when compared with naïve female patients without IRIS. BMI (18-26), hemoglobin level below 8 g/dl, TLC, serum albumin level below 5 g/dl, HDL level below 61 mg/dl, ESR level, CRP value and absolute eosinophil count showed significant (P<0.05) difference between HAART naïve and on HAART male patients with IRIS. Hemoglobin level, HDL, TLC, ESR, CD8, AEC, viral load, BMI and serum albumin level showed significant (P<0.0001) difference among HAART initiated patients with IRIS when compared to different level of CD4 T cell count. Conclusion: Prevalence of anemia was high in HAART naïve patients while leucopenia prevalence was higher in patients on HAART and their prevalence increased as the CD4 count decreased. HIV Patients should be investigated for hematological and immunological changes following with appropriate therapeutic interventions. The study findings reemphasize the importance of nutritional and immunological parameters to assess the stage of the disease, initiate antiretroviral therapy and monitor the response in disease progression.