Steroids are a risk factor for Kaposi's sarcoma-immune reconstitution inflammatory syndrome and mortality in HIV infection.
AIDS
; 30(6): 909-14, 2016 Mar 27.
Article
em En
| MEDLINE
| ID: mdl-26636923
OBJECTIVES: To investigate the association between Kaposi's sarcoma-associated immune reconstitution inflammatory syndrome (KS-IRIS) and mortality, with the use of glucocorticoids in HIV-infected individuals. DESIGN: Case-control study. METHODS: We reviewed the medical records of 145 individuals with HIV-associated Kaposi's sarcoma receiving antiretroviral therapy. The association of different variables with KS-IRIS and Kaposi's sarcoma-related mortality was explored by univariate and multivariate analyses. The main exposure of interest was the use of glucocorticoids. We also compared the time to KS-IRIS and the time to death of individuals treated with glucocorticoids vs. those nontreated with glucocorticoids, and the time to death of individuals with KS-IRIS vs. those without KS-IRIS by hazards regression. RESULTS: Sixty of 145 individuals received glucocorticoids (41.4%) for the management or suspicion of Pneumocystis jirovecii pneumonia. Fifty individuals had KS-IRIS (37%). The use of glucocorticoids was more frequent in individuals with KS-IRIS than in those without KS-IRIS (54.9 vs. 36.47%, Pâ=â0.047). Kaposi's sarcoma-related mortality occurred in 17 cases (11.7%), and glucocorticoid use was more frequent in this group (76.47 vs. 36.7%, Pâ=â0.003). Glucocorticoid use was a risk factor for mortality (adjusted odds ratioâ=â4.719, 95% confidence intervalâ=â1.383-16.103, Pâ=â0.0132), and was associated with shorter periods to KS-IRIS (Pâ=â0.03) and death (Pâ=â0.0073). KS-IRIS was a risk factor for mortality (Pâ=â0.049). CONCLUSION: In HIV-infected individuals, the use of glucocorticoids is a risk factor for KS-IRIS and Kaposi's sarcoma-associated mortality. In addition, KS-IRIS is a risk factor for mortality. Therefore, glucocorticoid administration in this population requires careful consideration based on individualized risk-benefit analysis.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pneumonia por Pneumocystis
/
Sarcoma de Kaposi
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Esteroides
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Infecções por HIV
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Síndrome Inflamatória da Reconstituição Imune
/
Imunossupressores
Tipo de estudo:
Etiology_studies
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Observational_studies
/
Risk_factors_studies
Limite:
Adult
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Female
/
Humans
/
Male
Idioma:
En
Revista:
AIDS
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
México
País de publicação:
Reino Unido