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Abstract Details

HIV central nervous system immune reconstitution inflammatory syndrome (CNS IRIS): Diagnostic challenges in resource-limited settings
Global Health and Neuroepidemiology
P9 - Poster Session 9 (12:00 PM-1:00 PM)
13-002
To determine the proportion of Zambian HIV+ patients presenting with neurological symptoms that meet standard IRIS diagnostic criteria. 
The diagnosis of IRIS is based on evidence of clinical worsening and immune reconstitution in the setting of antiretroviral (ARV) initiation. While CNS IRIS is thought to be prevalent in resource limited settings (RLS), its identification is limited  by data on pre-treatment HIV disease. In the CNS, an IRIS diagnosis can be improved with imaging and cerebrospinal fluid (CSF) studies, which are not universally available in RLS. This study evaluated the capacity to diagnose CNS IRIS at a tertiary care facility in Lusaka, Zambia.
We performed a retrospective chart review of HIV+ individuals in a cohort study of patients with suspected tuberculosis meningitis. Eligible participants included those who were HIV+, on ARVs, with a CD4 count <200 cells/mm3. We recorded information regarding  HIV history, clinical presentation and evaluation. We categorized patients as probable, possible, or unlikely CNS IRIS based on standard definitions.
Of 572 patients in the cohort, 139 met inclusion criteria. None of the 139 participants met probable criteria, as there was no information on HIV viral load or prior CD4 counts. Sixty-seven (48%) participants met possible criteria, 20 of whom had evidence of CNS TB; 10 of the 20 had a history of prior TB infection. Seventy-two (52%) were unlikely to be IRIS due to duration of ARV use < 1 week or > 1 year. Only 4 patients (3%) had neuroimaging.

The absence of baseline HIV disease data and lack of neuroimaging facilities limits the ability to diagnose CNS IRIS in RLS.  

 
Authors/Disclosures
Allison P. Navis, MD (Mount Sinai Hospital)
PRESENTER 		The institution of Dr. Navis has received research support from NIH Loan Repayment Program.
Omar Siddiqi, MD (Beth Israel Deaconess Medical Center) The institution of Dr. Siddiqi has received research support from NIH.
No disclosure on file
Gretchen L. Birbeck, MD, MPH, DTMH, FÂ鶹´«Ã½Ó³»­ (University of Rochester/CHET) An immediate family member of Dr. Birbeck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Birbeck has a non-compensated relationship as a Ambassador for Zambia with RSTMH that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.