ASSESSMENT OF HIGH-RISK GROUP FOR IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) DEVELOPMENT AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS/ ACQUIRED IMMUNODEFICIENCY SYNDROME (HIV/AIDS) IN NEPAL
Mishra S. K., Napit R., Bastola A. and Manandhar K. D.*
Background: Immune Reconstitution Inflammatory Syndrome (IRIS) a clinical condition which is a side effect of Anti-Retroviral Therapy (ART) due to rapid recovery of Immune system leading to adverse effects. So far, Predicting IRIS have not been difficult but recently some research showed it can be narrowed down to the high-risk group on the basis of cluster differentiation (CD4+ & CD8+) level and of CD4+ /CD8+ ratio. Methods: The study was carried out at National Public Health laboratory, the apex laboratory of Government of Nepal; and Sukraraj Tropical Infectious Disease Hospital (STIDH). Includes 1060 HIV infected people and Cluster Differentiation (CD) profile was enumerated by Fluorescent Activated Cell Sorting (FACS) caliber machine. All the data were collected systematically and arranged in a tabular form and statistically analyzed using Graph Pad Prism ver7.0 to check the characteristics of population along with other statistical tests. Results: The study was carried out with 1006 HIV infected patients consisting of 60.7% male and 39.2% female. CD4+/CD8+ ratio was taken as major predictor and tested, CD4+/CD8+ ratio value was divided into four group to simplify analysis (>1.5, 0.3-1.5, 0.15-0.3 and <0.15). 75 percentiles of people had CD4+/CD8+ ratio value of below 0.5 indicating poor immune status. Out of 1006 HIV patients included in this study only 44 showed IRIS within six months of starting ART and all of them had CD4+/CD8+ ratio of below 0.15 (considered as high-risk group in this study). Also, chi-square test showed positive association between IRIS cases and CD4+/CD8+ ratio along with sex and Age. All the IRIS confirmed cases lied in the high-risk group and were indicated by CD4+/CD8+ ratio value before starting ART. Conclusions: More than 75 percentiles of people living with HIV/AIDS (PLHIV) showed abnormal CD4+/CD8+ratio of below 0.5. The incidence of IRIS among ART initiator PLHIV was identified as High-Risk group using CD4+/CD8+ ratio more accurately in Nepalese people. Hence, CD4+/CD8+ ratio measurement will help narrow down high-risk group of IRIS cases among PLHIV initiating ART. Treatment of IRIS will remain a clinical challenge due to the variety of clinical presentations and the presence of multiple pathogens capable of causing the syndrome. Patients at greatest risk for the development of serious IRIS events, a low CD4+/CD8+ ratio of <0.15, should be screened to exclude an active or subclinical infection with important opportunistic.
Keywords: IRIS, CD4+, CD8+, HIV, Nepal, PLHIV
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