Immune reconstitution inflammatory syndrome in a resource-poor setting

Stephen A. Klotz, Abdul Aziz Mohammed, Mulugeta Girmai Woldemichael, Mongistu Worku Mitku, Mitchell Handrich

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm 3. Ninety-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRIS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.

Original languageEnglish (US)
Pages (from-to)122-127
Number of pages6
JournalJournal of the International Association of Physicians in AIDS Care
Issue number2
StatePublished - Mar 2009


  • AIDS
  • Africa
  • Ethiopia
  • IRIS
  • gastroenteritis

ASJC Scopus subject areas

  • Immunology
  • Dermatology
  • Infectious Diseases


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