Immune reconstitution inflammatory syndrome associated with Kaposi's sarcoma
Immune reconstitution inflammatory syndrome associated with Kaposi's sarcoma
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DOI：
10.1200/jco.2005.14.597
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发表时间：
2005-08-01
影响因子：
45.3
通讯作者：
Stebbing, J
中科院分区：
文献类型：
--
作者：
Bower, M;Nelson, M;Stebbing, J
目的：尽管病毒学和免疫学参数得到控制，但一部分HIV感染患者随后接受高效抗逆转录病毒治疗（HAART）后，其临床状态出现恶化。这种临床反应，被称为免疫重建炎症综合征（IRIS），发生继发于对以前诊断的pathogenes.Patients和方法的免疫反应从我们的队列中的5,832例患者治疗的HAART时代，我们确定了150治疗初治的卡波西肉瘤（KS）的第一个介绍的患者。结果HAART治疗后，10例（6.6%）患者发生了进行性KS，我们将其确定为IRIS相关KS。在这些个体与KS没有进展的个体的比较中，我们发现IRIS-KS发生在具有较高CD 4计数（P = 0.03）、KS相关水肿（P = 0.01）和同时使用蛋白酶抑制剂和非核苷类药物治疗（P = 0.03）的患者中。两组治疗失败的时间相似，但在IRIS相关KS患者中，CD 4计数最初下降更快。尽管这种最初的下降，在我们的临床经验HAART可以成功地继续在那些与IRIS相关的KS.Conclusion我们已经确定了IRIS-KS在一个队列的艾滋病患者KS谁开始HAART。
Purpose A proportion of patients with HIV infection who subsequently receive highly active antiretroviral therapy (HAART) exhibit a deterioration in their clinical status, despite control of virologic and immunologic parameters. This clinical response, known as the immune reconstitution inflammatory syndrome (IRIS), occurs secondary to an immune response against previously diagnosed pathogens.Patients and Methods From our cohort of 5,832 patients treated in the HAART era, we identified 150 therapy-naive patients with a first presentation of Kaposi's sarcoma (KS). Their clinicopathologic features and progress were recorded prospectively.Results After commencing HAART, ten patients (6.6%) developed progressive KS, which we identify as IRIS-associated KS. In a comparison of these individuals with those whose KS did not progress, we found that IRIS-KS occurred in patients with higher CD4 counts (P = .03), KS-associated edema (P = .01), and therapy with both protease inhibitors and non-nucleosides together (P = .03). Time to treatment failure was similar for both groups, although the CD4 count declined more rapidly at first, in those patients with IRIS-associated KS. Despite this initial decline, in our clinical experience HAART could be successfully continued in those with IRIS-associated KS.Conclusion We have identified IRIS-KS in a cohort of HIV patients with KS who start HAART.