Mycobacterium avium complex immune reconstitution inflammatory syndrome: Long term outcomes

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Mycobacterium avium complex immune reconstitution inflammatory syndrome: Long term outcomes James Riddell IV1, Daniel R Kaul1,4, Petros C Karakousis2, Joel E Gallant2, Jennifer Mitty3 and Powel H Kazanjian*1 Address: 1Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA, 2Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, 3Department of Internal Medicine, Division of Infectious Diseases, Brown University, Providence, Rhode Island, USA and 4Methodist Hospital, Indianapolis, Indiana, USA Email: James Riddell - [email protected]; Daniel R Kaul - [email protected]; Petros C Karakousis - [email protected]; Joel E Gallant - [email protected]; Jennifer Mitty - [email protected]; Powel H Kazanjian* - [email protected] * Corresponding author

Published: 15 October 2007 Journal of Translational Medicine 2007, 5:50

doi:10.1186/1479-5876-5-50

Received: 10 July 2007 Accepted: 15 October 2007

This article is available from: http://www.translational-medicine.com/content/5/1/50 © 2007 Riddell et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background: To describe long term outcomes of Mycobacterium avium complex (MAC) immune reconstitution inflammatory syndrome (IRIS). Methods: Cases of MAC IRIS were retrospectively identified at four HIV clinics (Michigan, Maryland, Rhode Island, and Indiana) from 1996–2004. Patients were included if they were initially diagnosed with AIDS and found to have evidence of focal MAC infection documented by tissue culture or PCR after initiating HAART, and at least 6 months of follow up. Results: Among the 20 patients included, the mean age was 40 years, mean CD4 cell count was 24/mm3 at pretreatment baseline and 100/mm3 at time of MAC IRIS diagnosis. Sites of disease included lymph nodes (15 patients [8 peripheral, 8 abdominal and 1 peripheral and abdominal]), gastrointestinal tract (7) and liver (3). Sixteen patients (80%) responded to treatment and were disease free after a mean of 17.4 months of therapy for MAC IRIS; IRIS therapy was withdrawn in 6 without relapse. Four patients (non-responder group) had persistent or relapsing disease despite 27 months of ongoing MAC IRIS treatment. At the time of resolution or last follow-up, the mean CD4 cell count and viral load was 143/mm3 and 7,000 c/mL for responders, and 65/mm3 and 17,000 c/mL for non-responders, respectively. Most patients with peripheral adenopathy were responders (7/8; 88%); many with abdominal adenopathy (4/8; 50%) were nonresponders. Conclusion: The majority of patients with MAC IRIS eventually responded to treatment. Our sample size was not adequate to perform statistical anal