Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis.
Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(10)70026-8
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发表时间：
2010-04
影响因子：
56.3
通讯作者：
Egger, Matthias
中科院分区：
文献类型：
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作者：
Mueller, Monika;Wandel, Simon;Colebunders, Robert;Attia, Suzanna;Furrer, Hansjakob;Egger, Matthias
这篇系统的综述考察了开始抗逆转录病毒联合治疗(ART)的HIV-1感染患者免疫重建疾病(IRD)的发生率。我们分析了54项队列研究中的13103名患者，其中1,685名患者发生了IRD。使用贝叶斯方法计算95%可信区间(CRI)的合并事件。在既往诊断为艾滋病的患者中，巨细胞病毒视网膜炎的发病率为37.7%(95%CRI 26.6-49.4%)，隐球菌性脑膜炎为19.5%(6.7-44.8%)，肺结核为15.7%(9.7-24.5%)，进行性多灶性白质脑病为16.7%(2.3-50.7%)，卡波西肉瘤为6.4%(1.2-24.7%)。根据对开始抗逆转录病毒治疗的未选定患者的研究，任何类型的IRD的发生率为16.1%(11.1-22.9%)。致死率分别为4.5%(2.1-8.6%)、3.2%(0.7-9.2%)和20.8%(5.0-52.7%)。Meta回归分析显示，发病在很大程度上是由抗逆转录病毒治疗开始时的CD_4细胞计数决定的，低于50个/μL的患者是高风险的。因此，如果尽早开始抗逆转录病毒治疗，许多IRD事件可能会被预防。
This systematic review examines the incidence of Immune Reconstitution Disease (IRD) in HIV-1 infected patients starting antiretroviral combination therapy (ART). We analysed 13103 patients from 54 cohort studies; 1685 patients developed IRD. Pooled incidences with 95% credibility intervals (CrI) were calculated using Bayesian methods. In patients with previously diagnosed AIDS-defining conditions the incidence was 37.7% (95% CrI 26.6–49.4%) for CMV retinitis, 19.5% (6.7–44.8%) for cryptococcal meningitis, 15.7% (9.7–24.5%) for tuberculosis, 16.7% (2.3–50.7%) for progressive multifocal leukencephalopathy and 6.4% (1.2–24.7%) for Kaposi’s sarcoma. The incidence of any type of IRD, based on studies of unselected patients starting ART, was 16.1% (11.1–22.9%). Lethality was 4.5% (2.1–8.6%) for any type of IRD, 3.2% (0.7–9.2%) for tuberculosis and 20.8% (5.0–52.7%) for cryptococcal meningitis. Meta-regression analyses showed that the incidence is largely determined by the CD4 cell count at the start of ART, with a high risk in patients starting below 50 cells/μl. Many of the IRD events might therefore be prevented with earlier initiation of ART.