@article{3002849,
    title = "Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries",
    author = "Lodi, S. and Del Amo, J. and Moreno, S. and Bucher, H.C. and Furrer, H. and Logan, R. and Sterne, J. and Pérez-Hoyos, S. and Jarrín, I. and Phillips, A. and Olson, A. and Van Sighem, A. and Reiss, P. and Sabin, C. and Jose, S. and Justice, A. and Goulet, J. and Miró, J.M. and Ferrer, E. and Meyer, L. and Seng, R. and Vourli, G. and Antoniadou, A. and Dabis, F. and Vandenhede, M.-A. and Costagliola, D. and Abgrall, S. and Hernán, M.A. and Hernan, M. and Bansi, L. and Hill, T. and Sabin, C. and Dunn, D. and Porter, K. and Glabay, A. and Orkin, C. and Thomas, R. and Jones, K. and Fisher, M. and Perry, N. and Pullin, A. and Churchill, D. and Gazzard, B. and Nelson, M. and Asboe, D. and Bulbeck, S. and Mandalia, S. and Clarke, J. and Delpech, V. and Anderson, J. and Munshi, S. and Post, F. and Easterbrook, P. and Khan, Y. and Patel, P. and Karim, F. and Duffell, S. and Gilson, R. and Man, S.-L. and Williams, I. and Gompels, M. and Dooley, D. and Schwenk, A. and Ainsworth, J. and Johnson, M. and Youle, M. and Lampe, F. and Smith, C. and Grabowska, H. and Chaloner, C. and Ismajani Puradiredja, D. and Bansi, L. and Hill, T. and Phillips, A. and Sabin, C. and Walsh, J. and Weber, J. and Kemble, C. and Mackie, N. and Winston, A. and Leen, C. and Wilson, A. and Bezemer, D.O. and Gras, L.A.J. and Kesselring, A.M. and Van Sighem, A.I. and Zaheri, S. and Van Twillert, G. and Kortmann, W. and Branger, J. and Prins, J.M. and Kuijpers, T.W. and Scherpbier, H.J. and Van Der Meer, J.T.M. and Wit, F.W.M.N. and Godfried, M.H. and Reiss, P. and Van Der Poll, T. and Nellen, F.J.B. and Lange, J.M.A. and Geerlings, S.E. and Van Vugt, M. and Pajkrt, D. and Bos, J.C. and Van Der Valk, M. and Grijsen, M.L. and Wiersinga, W.J. and Brinkman, K. and Blok, W.L. and Frissen, P.H.J. and Schouten, W.E.M. and Van Den Berk, G.E.L. and Veenstra, J. and Lettinga, K.D. and Mulder, J.W. and Vrouenraets, S.M.E. and Lauw, F.N. and Van Eeden, A. and Verhagen, D.W.M. and Van Agtmael, M.A. and Perenboom, R.M. and Claessen, F.A.P. and Bomers, M. and Peters, E.J.G. and Richter, C. and Van Der Berg, J.P. and Gisolf, E.H. and Schippers, E.F. and Van Nieuwkoop, C. and Van Elzakker, E.P. and Leyten, E.M.S. and Gelinck, L.B.S. and Pronk, M.J.H. and Bravenboer, B. and Kootstra, G.J. and Delsing, C.E. and Sprenger, H.G. and Doedens, R. and Scholvinck, E.H. and Van Assen, S. and Bierman, W.F.W. and Soetekouw, R. and Ten Kate, R.W. and Van Vonderen, M.G.A. and Van Houte, D.P.F. and Kroon, F.P. and Van Dissel, J.T. and Arend, S.M. and De Boer, M.G.J. and Jolink, H. and Ter Vollaard, H.J.M. and Bauer, M.P. and Weijer, S. and El Moussaoui, R. and Lowe, S. and Schreij, G. and Oude Lashof, A. and Posthouwer, D. and Koopmans, P.P. and Keuter, M. and Van Der Ven, A.J.A.M. and Ter Hofstede, H.J.M. and Dofferhoff, A.S.M. and Warris, A. and Van Crevel, R. and Van Der Ende, M.E. and De Vries-Sluijs, T.E.M.S. and Schurink, C.A.M. and Nouwen, J.L. and Nispen Tot Pannerden, M.H. and Verbon, A. and Rijnders, B.J.A. and Van Gorp, E.C.M. and Hassing, R.J. and Smeulders, A.W.M. and Hartwig, N.G. and Driessen, G.J.A. and Den Hollander, J.G. and Pogany, K. and Juttmann, J.R. and Van Kasteren, M.E.E. and Hoepelman, A.I.M. and Mudrikova, T. and Schneider, M.M.E. and Jaspers, C.A.J.J. and Ellerbroek, P.M. and Oosterheert, J.J. and Arends, J.E. and Wassenberg, M.W.M. and Barth, R.E. and Geelen, S.P.M. and Wolfs, T.F.W. and Bont, L.J. and Van Den Berge, M. and Stegeman, A. and Groeneveld, P.H.P. and Alleman, M.A. and Bouwhuis, J.W. and Barin, F. and Burty, C. and Duvivier, C. and Enel, P. and Fredouille-Heripret, L. and Gasnault, J. and Khuong, M.A. and Mahamat, A. and Pilorgé, F. and Tattevin, P. and Salomon, V. and Jacquemet, N. and Abgrall, S. and Costagliola, D. and Grabar, S. and Guiguet, M. and Lanoy, E. and Lièvre, L. and Mary-Krause, M. and Selinger-Leneman, H. and Lacombe, J.M. and Potard, V. and Bricaire, F. and Herson, S. and Katlama, C. and Simon, A. and Desplanque, N. and 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M.F. and Hoen, B. and Eglinger, P. and Faller, J.P. and Borsa-Lebas, F. and Caron, F. and Reynes, J. and Daures, J.P. and May, T. and Rabaud, C. and Berger, J.L. and Rémy, G. and Arlet-Suau, E. and Cuzin, L. and Massip, P. and Thiercelin Legrand, M.F. and Pontonnier, G. and Viget, N. and Yasdanpanah, Y. and Dellamonica, P. and Pradier, C. and Pugliese, P. and Aleksandrowicz, K. and Quinsat, D. and Ravaux, I. and Tissot-Dupont, H. and Delmont, J.P. and Moreau, J. and Gastaut, J.A. and Poizot-Martin, I. and Retornaz, F. and Soubeyrand, J. and Galinier, A. and Ruiz, J.M. and Allegre, T. and Blanc, P.A. and Bonnet-Montchardon, D. and Lepeu, G. and Granet-Brunello, P. and Esterni, J.P. and Pelissier, L. and Cohen-Valensi, R. and Nezri, M. and Chadapaud, S. and Laffeuillade, A. and Billaud, E. and Raffi, F. and Boibieux, A. and Peyramond, D. and Livrozet, J.M. and Touraine, J.L. and Cotte, L. and Trepo, C. and Strobel, M. and Bissuel, F. and Pradinaud, R. and Sobesky, M. and Cabié, A. and 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Marco, A. and Quintana, M. and Gonzalez, C. and Castilla, J. and Guevara, M. and De Mendoza, C. and Zahonero, N. and Ortíz, M. and Paraskevis, D. and Touloumi, G. and Pantazis, N. and Bakoyannis, G. and Gioukari, V. and Antoniadou, A. and Papadopoulos, A. and Petrikkos, G. and Daikos, G. and Psichogiou, M. and Gargalianos-Kakolyris, P. and Xylomenos, G. and Katsarou, O. and Kouramba, A. and Ioannidou, P. and Kordossis, T. and Kontos, A. and Lazanas, M. and Chini, M. and Tsogas, N. and Panos, G. and Paparizos, V. and Leuow, K. and Kourkounti, S. and Sambatakou, H. and Mariolis, I. and Skoutelis, A. and Papastamopoulos, V. and Baraboutis, I. and The HIV-CAUSAL Collaboration",
    journal = "Ελληνικά Αρχεία AIDS=:  Hellenic Archives of AIDS",
    year = "2014",
    volume = "28",
    number = "16",
    pages = "2461-2473",
    publisher = "Lippincott Williams and Wilkins",
    issn = "11058900",
    doi = "10.1097/QAD.0000000000000456",
    keywords = "antiretrovirus agent, acquired immune deficiency syndrome;  adult;  Article;  candidiasis;  CD4 lymphocyte count;  cryptococcosis;  Cytomegalovirus retinitis;  female;  follow up;  Herpes simplex virus;  highly active antiretroviral therapy;  human;  immune reconstitution inflammatory syndrome;  incidence;  Kaposi sarcoma;  major clinical study;  male;  nonhodgkin lymphoma;  opportunistic infection;  outcome assessment;  progressive multifocal leukoencephalopathy;  tuberculosis;  virus infection;  adolescent;  aged;  AIDS-Related Opportunistic Infections;  developed country;  Europe;  HIV Infections;  middle aged;  Neoplasms;  procedures;  United States;  young adult, Adolescent;  Adult;  Aged;  AIDS-Related Opportunistic Infections;  Anti-Retroviral Agents;  Antiretroviral Therapy, Highly Active;  Developed Countries;  Europe;  Female;  HIV Infections;  Humans;  Incidence;  Male;  Middle Aged;  Neoplasms;  United States;  Young Adult",
    abstract = "Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis.
Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting.
Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis.
Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins."
}