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responded to treatment and were disease free after a mean of 17.4 months of therapy for MAC IRIS; IRIS therapy was withdrawn in 6 without relapse.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 analysis, but there was a tendency towards adequate CD4 response to HAART and peripheral rather than intraabdominal adenopathy among responders.
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机译：背景技术描述鸟分枝杆菌复合物（MAC）免疫重建炎症综合症（IRIS）的长期结果。方法回顾性分析1996年至2004年间在四个HIV诊所（密歇根州，马里兰州，罗德岛州和印第安纳州）的MAC IRIS病例。如果患者最初被诊断出患有AIDS，并且在开始HAART后至少进行了6个月的随访，则通过组织培养或PCR证实有局灶性MAC感染的证据。结果纳入的20例患者中，平均年龄为40岁，在治疗前基线时平均CD4细胞计数为24 / mm 3 ，在MAC IRIS时为100 / mm 3 诊断。疾病部位包括淋巴结肿大（15例[8例外周，8例腹部，1例外周和腹部]），胃肠道（7例）和肝脏（3例）。对MAC IRIS进行平均17.4个月的治疗后，有16名患者（80％）对治疗有反应，并且没有疾病;有6例患者退出IRIS治疗，且未复发。尽管进行了27个月的MAC IRIS治疗，但四名患者（无反应者组）仍患有持续性或复发性疾病。在解决方案或最后一次随访时，平均CD4细胞计数和病毒载量为143 / mm 3 ，应答者为7,000 c / mL，65 / mm 3 和17,000 c / mL分别用于无反应者。大多数周围性腺病患者是有反应的（7/8; 88％）。许多腹部腺病患者（4/8; 50％）无反应。结论大多数MAC IRIS患者最终对治疗有反应。我们的样本量不足以进行统计分析，但应答者中有对HAART和外周而非腹部内腺病充分CD4反应的趋势。
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