Johns Hopkins researchers have identified risk factors for immune reconstitution inflammatory syndrome (IRIS), symptoms of opportunistic infections seen in some people who are otherwise responding well to antiretroviral (ARV) therapy.  The new findings, authored by Yukari Manabe, MD, of the Johns Hopkins Center for Tuberculosis Research in Baltimore, and her colleagues, are published in the December 1 issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

When people with HIV start ARV therapy, they sometimes experience symptoms of underlying diseases like tuberculosis, mycobacterium avium complex (MAC) and cytomegalovirus (CMV). These symptoms, which can cause serious illness, are believed to be caused by the recovery of immune function that effective ARV treatment produces.

Dr. Manabe’s team found 49 Johns Hopkins HIV Clinic patients who developed IRIS and compared them to people who started ARV treatment without developing IRIS. The most important risk factors for developing IRIS were starting treatment with a Norvir (ritonavir) boosted protease inhibitor, a low CD4 count or a higher viral load. Patients who had all three risk factors when starting treatment were the most likely to develop IRIS.