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Immune Reconstitution Inflammatory Syndrome in HIV-Infected Immigrants

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  • 1 Internal Medicine, Hospital San Roque Maspalomas (HSRM), Gran Canaria, Spain;
  • | 2 Department of Medical and Surgical Sciences, University of Las Palmas, Las Palmas, Spain;
  • | 3 Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain;
  • | 4 Internal Medicine, Puerta de Hierro Hospital, Madrid, Spain

Immune reconstitution inflammatory syndrome (IRIS) includes a group of potentially serious inflammatory processes that may be present in HIV-infected patients after initiating highly active antiretroviral therapy (HAART). Paradoxical IRIS is a worsening of symptoms, after an overwhelming response to a previously diagnosed opportunistic infection (OI); unmasking IRIS reveals a previously occult OI. The main objective of the study was to describe the epidemiological, clinical, and outcome data of HIV-infected immigrants, stratified according to high- or low-income countries of origin, who developed IRIS and to compare them with native-born Spanish patients. This retrospective study reviewed all patients with HIV infection admitted to the Unit of Infectious Diseases and Tropical Medicine between 1998 and 2014. IRIS was identified in 25/138 (18%) immigrant patients and 24/473 (5%) native-born Spanish patients infected with HIV. Most cases, 19/25 (76%), were of unmasking IRIS. The time elapsed between initiation of HAART and development of IRIS was significantly longer in patients with unmasking versus paradoxical IRIS. OIs, in particular due to mycobacteria, were the most frequently involved processes. Twenty percent of patients died. The comparison of immigrant and native-born patients found significant differences for both IRIS type (higher incidence of paradoxical forms among immigrants) and for the absence of malignancies in native-born patients. No significant differences were found when the data of immigrants from low- and high-income countries were compared.

Author Notes

Address correspondence to José-Luis Pérez-Arellano, Department of Medical and Surgical Sciences, University of Las Palmas, Avda Marítima del Sur, Las Palmas 35080, Spain and Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Avda Marítima del Sur, Las Palmas 35080, Spain. E-mail: jlperez@dcmq.ulpgc.es

Authors’ addresses: María Pérez-Rueda, Internal Medicine, Hospital San Roque Maspalomas (HSRM), Gran Canaria, Spain, E-mail: dra.perezrueda@gmail.com. Michele Hernández-Cabrera, Elena Pisos-Álamo, Nieves Jaén-Sánchez, Cristina Carranza-Rodríguez, and Jose-Luis Pérez-Arellano, Department of Medical and Surgical Sciences, University of Las Palmas, Las Palmas, Spain, and Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain, E-mails: michele_herca@hotmail.com, elenapisos@yahoo.es, nieves.jaensanchez@gmail.com, cristinacarranzarodriguez@gmail.com, and jlperez@dcmq.ulpgc.es. Adela Francés-Urmeneta, Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain, E-mail: adelafrances@telefonica.net. Alfonso Angel-Moreno, Internal Medicine, Puerta de Hierro Hospital, Madrid, Spain, E-mail: alfangel22@hotmail.com.

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