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Results: 4

2.
Figure 2

Figure 2. Rate of IRIS and non-IRIS events over 24 weeks from anti-retroviral therapy (ART).. From: Incidence, Clinical Spectrum, Risk Factors and Impact of HIV-Associated Immune Reconstitution Inflammatory Syndrome in South Africa.

Rates are calculated per 100 patient-years (PY) in 3-week intervals, with 95% confidence intervals. Separate plots are shown for paradoxical IRIS (▴), unmasking IRIS (•) and non-IRIS events (×). Rate of non-IRIS events in the first 3 weeks was 741 events/100 PY (95% confidence interval 648–848) (data not plotted).

Lewis John Haddow, et al. PLoS One. 2012;7(11):e40623.
3.
Figure 4

Figure 4. Multivariable analysis of risk factors for IRIS according to subtype.. From: Incidence, Clinical Spectrum, Risk Factors and Impact of HIV-Associated Immune Reconstitution Inflammatory Syndrome in South Africa.

A, paradoxical IRIS related to major OIs (19 events in 135 patients [n = 15 TB]); B, unmasking IRIS related to major OIs (25 events in 498 patients [n = 19 TB]); C, paradoxical mucocutaneous IRIS (31 events in 418 patients); D, unmasking mucocutaneous IRIS (64 events in 498 patients). All variables were pre-ART unless stated. Potential risk factors were excluded from multivariable models if P≥0.10 on univariate analysis. LN: lymphadenopathy; OI: opportunistic infection.

Lewis John Haddow, et al. PLoS One. 2012;7(11):e40623.
4.
Figure 1

Figure 1. Clinical spectrum of 139 IRIS events by mode of presentation (paradoxical or unmasking) and underlying diagnosis.. From: Incidence, Clinical Spectrum, Risk Factors and Impact of HIV-Associated Immune Reconstitution Inflammatory Syndrome in South Africa.

* Features of oesophagitis IRIS were odynophagia with significant anorexia, endoscopic findings, or haematemesis, with a clinical course consistent with paradoxical or unmasking IRIS and not typical of reflux or other common causes. ** The strongyloides IRIS case was unusual in its severity (it was diagnosed post mortem); the arguments that this case was IRIS have been published in a case report [67]. *** Based on clinical evidence of genital ulcer disease (GUD), pre-ART serologic evidence of herpes simplex virus (HSV)-2 infection, and exclusion of syphilis or confirmation of HSV-2 by polymerase chain reaction on ulcer swab. A diagnosis of unmasking HSV-IRIS was based on new onset GUD despite pre-ART serologic evidence of herpes simplex virus (HSV)-2 infection. A diagnosis of paradoxical HSV-IRIS was based on increasing frequency and/or severity of episodes of known recurrent genital herpes, relative to pre-ART. Anti-herpetic therapy was not available in this setting. **** Genital, orolabial or generalised warts. Unmasking IRIS involving genital warts was supported by a history of sexual abstinence since prior to ART initiation. ***** Intra-oral pain and ulceration (n = 6), or extra-oral ulceration (n = 3, one involving most of the face), with virological confirmation of HSV-1 by polymerase chain reaction, or no other likely causative organism. ****** Features suggestive of tinea IRIS were: unusually rapid spread of lesions, or marked inflammation. There were 18 more “typical” non-IRIS tinea cases that occurred during an interruption in ART, or where clinical history was insufficient to support an IRIS diagnosis.

Lewis John Haddow, et al. PLoS One. 2012;7(11):e40623.

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