Case Descriptions of Mycobacterium avium Complex Immune Reconstitution Inflammatory Syndrome
| Age and Sex . | CD4+ T-Cell Count at Baseline (at IRIS) . | ART Regimen . | Other OIs (Before or at the Time of MAC Diagnosis) . | Time to IRIS From ART Initiation, d . | MAC Diagnosis . | MAC-IRIS Presentation . | MAC Therapy, d . | Corticosteroids for MAC Treatment . | Hospitalizations and Outcome . |
|---|---|---|---|---|---|---|---|---|---|
| 47 y, M | 7 (97) | ABC + 3TC, ATV | Esophageal candidiasis, oral candidiasis, CMV enterocolitis, cryptosporidiosis | 99 | Liver, lymph node aspirates grew MAC | Lymphadenopathy (unmasking IRIS) | Started 107 d after ART: • Azithromycin (1461) • Ethambutol (1461) | Prednisone | Hospitalized for 12 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, diarrhea, and vomiting). MAC-IRIS resolved after treatment with corticosteroids. |
| 27 y, M | 40 (108) | FTC + TDF, ZDV, ATV + RTV | Pneumocystis carinii pneumonia, HSV (perianal), Kaposi sarcoma, oral candidiasis, oral hairy leukoplakia | 38 | Biopsy of abdominal lymph node positive for MAI | Lymphadenopathy (unmasking IRIS) | Started 60 d after ART: • Clarithromycin (965) • Ethambutol (965) | None | Hospitalized for 3 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fevers, chills, myalgia, and vomiting). MAC-IRIS resolved without corticosteroids. |
| 48 y, F | 1 (48) | EFV + FTC + TDF | Pneumocystis carinii pneumonia, microsporidia, Cryptosporidium, oral candidiasis, genital/oral HSV | 18 | AFB blood culture grew MAC | Disseminated; high fever, hypotension, and tachycardia (unmasking IRIS) | Started 35 d after ART: • Azithromycin (141) • Ethambutol (141) • Moxifloxacin (140) | None | Hospitalized in ICU for 2 d for diagnostic workup of presenting MAC-IRIS symptoms (hypotension, tachycardia, fever). MAC-IRIS resolved without corticosteroids. |
| 25 y, M | 86 (488) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, oral candidiasis | 54 | Sputum positive for MAC by acid-fast stain, culture, and SecA1 PCR/sequencing | Pulmonary (unmasking IRIS) | Started 65 d after ART: • Azithromycin (495) • Ethambutol (495) • Moxifloxacin (495) | None | Briefly hospitalized for diagnostic workup of presenting MAC-IRIS symptoms (cough in the setting of new pulmonary lesions). MAC-IRIS resolved without corticosteroids. |
| 32 y, F | 5 (12) | ATV, FTC + TDF | Disseminated histoplasmosis, Strongyloides, toxoplasmosis, HSV (rectal), CMV viremia, baseline MAC | 44 | AFB blood culture grew MAC | Cervical lymphadenopathy (paradoxical IRIS) | Started 3 d before ART • Azithromycin (172) • Ethambutol (837) • Moxifloxacin (837) | Prednisone | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (cervical adenopathy and fever). MAC-IRIS resolved following approximately 4 mo of corticosteroid treatment. |
| 49 y, M | 2 (13) | FTC + TDF, ATV | CMV retinitis, HSV (perirectal), oral candidiasis, Candida esophagitis, baseline MAC | 93 | AFB blood culture grew MAC | Extensive abdominal lymphadenopathy (paradoxical IRIS) | Started 4 d before ART: • Azithromycin (341) • Ethambutol (808) • Moxifloxacin (467) | None | Briefly hospitalized for MAC-IRIS symptom management (abdominal pain and fever). MAC IRIS resolved without corticosteroids. |
| 45 y, M | 37 (124) | EFV + FTC + TDF | Oral candidiasis, CNS lymphoma | 14 | BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 19 d after ART: • Azithromycin (513) • Ethambutol (513) • Moxifloxacin (513) | Prednisolone | Hospitalized for 13 wk for CNS lymphoma, MAC-IRIS, and failure to thrive. Patient experienced sufficient recovery to allow for hospital discharge but died of sudden cardiac death at home 890 d after ART initiation. |
| 31 y, M | 4 (26) | ATV, FTC + TDF, RTV | Pneumocystis carinii pneumonia, HSV (rectal) | 14 | FNA of lymph node positive by AFB smear, BAL fluid grew MAC | Lymphadenopathy (unmasking IRIS) | Started 42 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (725) | Prednisone | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS recurred >2 y after initial diagnosis despite continuous ART and prolonged MAC treatment. |
| 44 y, M | 5 (119) | EFV + FTC + TDF | Pneumocystis carinii pneumonia | 21 | FNA of paratracheal lymph node positive for AFB by Fite stain, AFB culture of lymph node biopsy material grew MAC | Pulmonary (unmasking IRIS) | Started 48 d after ART: • Azithromycin (599) • Ethambutol (599) • Moxifloxacin (584) | None | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (fever, dry cough, and night sweats). MAC-IRIS resolved without corticosteroids. |
| 47 y, F | 3 (14) | EFV + FTC + TDF | Oral candidiasis, baseline MAC | 14 | AFB blood culture grew MAC | Extensive lymphadenopathy (paradoxical IRIS) | Started 42 d after ART: • Azithromycin (91) • Ethambutol (550) • Moxifloxacin (550) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, adenopathy, and tachycardia) provided through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 50 y, M | 25 (119) | EFV + FTC + TDF | Cryptococcal meningitis | 9 | AFB smear of material collected from FNA of abdominal mass positive; AFB culture of the fluid also grew MAC | Extensive mesenteric lymphadenopathy (unmasking IRIS) | Started 99 d after ART: • Azithromycin (86) • Ethambutol (72) • Rifabutin (86) | None | Extensive workup of MAC-IRIS presenting symptoms (weight loss with new abdominal mass on imaging) conducted primarily in the outpatient setting, with 2 brief hospitalizations. Diagnosis ultimately made following FNA of abdominal mass for AFB culture. MAC-IRIS resolved without corticosteroids. |
| 29 y, M | 29 (157) | RAL, FTC + TDF | None | 56 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 62 d after ART: • Azithromycin (611) • Ethambutol (611) • Moxifloxacin (611) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptom (pleuritic chest pain) provided with frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 39 y, M | 44 (178) | DRV, RAL, FTC + TDF | Strongyloides | 30 | Histologic diagnosis by granulomas on lung biopsy | Pulmonary (unmasking IRIS) | Started 71 d after ART: • Azithromycin (363) • Ethambutol (363) • Moxifloxacin (126) | None | Not hospitalized. Patient did not have clinical symptoms of MAC-IRIS; diagnostic workup revealing unmasking MAC-IRIS was prompted by newly positive PPD 4 wk after ART initiation. |
| 41 y, M | 35 (154) | EFV + FTC + TDF, RAL | Pneumocystis carinii pneumonia, CMV pneumonia | 32 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 42 d after ART: • Azithromycin (579) • Ethambutol (579) | None | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 37 y, F | 8 (11) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, HSV, oral candidiasis | 11 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 17 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (736) | Prednisone | Hospitalized for 10 d for diagnostic workup and management of MAC-IRIS symptoms in the setting of recent cancer treatment and neutropenia. MAC IRIS resolved. |
| Age and Sex . | CD4+ T-Cell Count at Baseline (at IRIS) . | ART Regimen . | Other OIs (Before or at the Time of MAC Diagnosis) . | Time to IRIS From ART Initiation, d . | MAC Diagnosis . | MAC-IRIS Presentation . | MAC Therapy, d . | Corticosteroids for MAC Treatment . | Hospitalizations and Outcome . |
|---|---|---|---|---|---|---|---|---|---|
| 47 y, M | 7 (97) | ABC + 3TC, ATV | Esophageal candidiasis, oral candidiasis, CMV enterocolitis, cryptosporidiosis | 99 | Liver, lymph node aspirates grew MAC | Lymphadenopathy (unmasking IRIS) | Started 107 d after ART: • Azithromycin (1461) • Ethambutol (1461) | Prednisone | Hospitalized for 12 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, diarrhea, and vomiting). MAC-IRIS resolved after treatment with corticosteroids. |
| 27 y, M | 40 (108) | FTC + TDF, ZDV, ATV + RTV | Pneumocystis carinii pneumonia, HSV (perianal), Kaposi sarcoma, oral candidiasis, oral hairy leukoplakia | 38 | Biopsy of abdominal lymph node positive for MAI | Lymphadenopathy (unmasking IRIS) | Started 60 d after ART: • Clarithromycin (965) • Ethambutol (965) | None | Hospitalized for 3 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fevers, chills, myalgia, and vomiting). MAC-IRIS resolved without corticosteroids. |
| 48 y, F | 1 (48) | EFV + FTC + TDF | Pneumocystis carinii pneumonia, microsporidia, Cryptosporidium, oral candidiasis, genital/oral HSV | 18 | AFB blood culture grew MAC | Disseminated; high fever, hypotension, and tachycardia (unmasking IRIS) | Started 35 d after ART: • Azithromycin (141) • Ethambutol (141) • Moxifloxacin (140) | None | Hospitalized in ICU for 2 d for diagnostic workup of presenting MAC-IRIS symptoms (hypotension, tachycardia, fever). MAC-IRIS resolved without corticosteroids. |
| 25 y, M | 86 (488) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, oral candidiasis | 54 | Sputum positive for MAC by acid-fast stain, culture, and SecA1 PCR/sequencing | Pulmonary (unmasking IRIS) | Started 65 d after ART: • Azithromycin (495) • Ethambutol (495) • Moxifloxacin (495) | None | Briefly hospitalized for diagnostic workup of presenting MAC-IRIS symptoms (cough in the setting of new pulmonary lesions). MAC-IRIS resolved without corticosteroids. |
| 32 y, F | 5 (12) | ATV, FTC + TDF | Disseminated histoplasmosis, Strongyloides, toxoplasmosis, HSV (rectal), CMV viremia, baseline MAC | 44 | AFB blood culture grew MAC | Cervical lymphadenopathy (paradoxical IRIS) | Started 3 d before ART • Azithromycin (172) • Ethambutol (837) • Moxifloxacin (837) | Prednisone | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (cervical adenopathy and fever). MAC-IRIS resolved following approximately 4 mo of corticosteroid treatment. |
| 49 y, M | 2 (13) | FTC + TDF, ATV | CMV retinitis, HSV (perirectal), oral candidiasis, Candida esophagitis, baseline MAC | 93 | AFB blood culture grew MAC | Extensive abdominal lymphadenopathy (paradoxical IRIS) | Started 4 d before ART: • Azithromycin (341) • Ethambutol (808) • Moxifloxacin (467) | None | Briefly hospitalized for MAC-IRIS symptom management (abdominal pain and fever). MAC IRIS resolved without corticosteroids. |
| 45 y, M | 37 (124) | EFV + FTC + TDF | Oral candidiasis, CNS lymphoma | 14 | BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 19 d after ART: • Azithromycin (513) • Ethambutol (513) • Moxifloxacin (513) | Prednisolone | Hospitalized for 13 wk for CNS lymphoma, MAC-IRIS, and failure to thrive. Patient experienced sufficient recovery to allow for hospital discharge but died of sudden cardiac death at home 890 d after ART initiation. |
| 31 y, M | 4 (26) | ATV, FTC + TDF, RTV | Pneumocystis carinii pneumonia, HSV (rectal) | 14 | FNA of lymph node positive by AFB smear, BAL fluid grew MAC | Lymphadenopathy (unmasking IRIS) | Started 42 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (725) | Prednisone | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS recurred >2 y after initial diagnosis despite continuous ART and prolonged MAC treatment. |
| 44 y, M | 5 (119) | EFV + FTC + TDF | Pneumocystis carinii pneumonia | 21 | FNA of paratracheal lymph node positive for AFB by Fite stain, AFB culture of lymph node biopsy material grew MAC | Pulmonary (unmasking IRIS) | Started 48 d after ART: • Azithromycin (599) • Ethambutol (599) • Moxifloxacin (584) | None | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (fever, dry cough, and night sweats). MAC-IRIS resolved without corticosteroids. |
| 47 y, F | 3 (14) | EFV + FTC + TDF | Oral candidiasis, baseline MAC | 14 | AFB blood culture grew MAC | Extensive lymphadenopathy (paradoxical IRIS) | Started 42 d after ART: • Azithromycin (91) • Ethambutol (550) • Moxifloxacin (550) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, adenopathy, and tachycardia) provided through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 50 y, M | 25 (119) | EFV + FTC + TDF | Cryptococcal meningitis | 9 | AFB smear of material collected from FNA of abdominal mass positive; AFB culture of the fluid also grew MAC | Extensive mesenteric lymphadenopathy (unmasking IRIS) | Started 99 d after ART: • Azithromycin (86) • Ethambutol (72) • Rifabutin (86) | None | Extensive workup of MAC-IRIS presenting symptoms (weight loss with new abdominal mass on imaging) conducted primarily in the outpatient setting, with 2 brief hospitalizations. Diagnosis ultimately made following FNA of abdominal mass for AFB culture. MAC-IRIS resolved without corticosteroids. |
| 29 y, M | 29 (157) | RAL, FTC + TDF | None | 56 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 62 d after ART: • Azithromycin (611) • Ethambutol (611) • Moxifloxacin (611) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptom (pleuritic chest pain) provided with frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 39 y, M | 44 (178) | DRV, RAL, FTC + TDF | Strongyloides | 30 | Histologic diagnosis by granulomas on lung biopsy | Pulmonary (unmasking IRIS) | Started 71 d after ART: • Azithromycin (363) • Ethambutol (363) • Moxifloxacin (126) | None | Not hospitalized. Patient did not have clinical symptoms of MAC-IRIS; diagnostic workup revealing unmasking MAC-IRIS was prompted by newly positive PPD 4 wk after ART initiation. |
| 41 y, M | 35 (154) | EFV + FTC + TDF, RAL | Pneumocystis carinii pneumonia, CMV pneumonia | 32 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 42 d after ART: • Azithromycin (579) • Ethambutol (579) | None | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 37 y, F | 8 (11) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, HSV, oral candidiasis | 11 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 17 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (736) | Prednisone | Hospitalized for 10 d for diagnostic workup and management of MAC-IRIS symptoms in the setting of recent cancer treatment and neutropenia. MAC IRIS resolved. |
Abbreviations: 3TC, lamivudine; ABC, abacavir; AFB, acid-fast bacilli; ART, antiretroviral therapy; ATV, atazanavir; BAL, bronchoalveolar lavage; CMV, cytomegalovirus; CNS, central nervous system; DRV, darunavir; EFV, efavirenz; F, female; FNA, fine needle aspiration; FTC, emtricitabine; HSV, herpes simplex virus; ICU, intensive care unit; IRIS, immune reconstitution inflammatory syndrome; M, male; MAI, Mycobacterium avium intracellulare; MAC, Mycobacterium avium complex; OI, opportunistic infection; PCR, polymerase chain reaction; PPD, purified protein derivative;; RAL, raltegravir; RTV, ritonavir; TDF, tenofovir; ZDV, zidovudine.
Case Descriptions of Mycobacterium avium Complex Immune Reconstitution Inflammatory Syndrome
| Age and Sex . | CD4+ T-Cell Count at Baseline (at IRIS) . | ART Regimen . | Other OIs (Before or at the Time of MAC Diagnosis) . | Time to IRIS From ART Initiation, d . | MAC Diagnosis . | MAC-IRIS Presentation . | MAC Therapy, d . | Corticosteroids for MAC Treatment . | Hospitalizations and Outcome . |
|---|---|---|---|---|---|---|---|---|---|
| 47 y, M | 7 (97) | ABC + 3TC, ATV | Esophageal candidiasis, oral candidiasis, CMV enterocolitis, cryptosporidiosis | 99 | Liver, lymph node aspirates grew MAC | Lymphadenopathy (unmasking IRIS) | Started 107 d after ART: • Azithromycin (1461) • Ethambutol (1461) | Prednisone | Hospitalized for 12 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, diarrhea, and vomiting). MAC-IRIS resolved after treatment with corticosteroids. |
| 27 y, M | 40 (108) | FTC + TDF, ZDV, ATV + RTV | Pneumocystis carinii pneumonia, HSV (perianal), Kaposi sarcoma, oral candidiasis, oral hairy leukoplakia | 38 | Biopsy of abdominal lymph node positive for MAI | Lymphadenopathy (unmasking IRIS) | Started 60 d after ART: • Clarithromycin (965) • Ethambutol (965) | None | Hospitalized for 3 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fevers, chills, myalgia, and vomiting). MAC-IRIS resolved without corticosteroids. |
| 48 y, F | 1 (48) | EFV + FTC + TDF | Pneumocystis carinii pneumonia, microsporidia, Cryptosporidium, oral candidiasis, genital/oral HSV | 18 | AFB blood culture grew MAC | Disseminated; high fever, hypotension, and tachycardia (unmasking IRIS) | Started 35 d after ART: • Azithromycin (141) • Ethambutol (141) • Moxifloxacin (140) | None | Hospitalized in ICU for 2 d for diagnostic workup of presenting MAC-IRIS symptoms (hypotension, tachycardia, fever). MAC-IRIS resolved without corticosteroids. |
| 25 y, M | 86 (488) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, oral candidiasis | 54 | Sputum positive for MAC by acid-fast stain, culture, and SecA1 PCR/sequencing | Pulmonary (unmasking IRIS) | Started 65 d after ART: • Azithromycin (495) • Ethambutol (495) • Moxifloxacin (495) | None | Briefly hospitalized for diagnostic workup of presenting MAC-IRIS symptoms (cough in the setting of new pulmonary lesions). MAC-IRIS resolved without corticosteroids. |
| 32 y, F | 5 (12) | ATV, FTC + TDF | Disseminated histoplasmosis, Strongyloides, toxoplasmosis, HSV (rectal), CMV viremia, baseline MAC | 44 | AFB blood culture grew MAC | Cervical lymphadenopathy (paradoxical IRIS) | Started 3 d before ART • Azithromycin (172) • Ethambutol (837) • Moxifloxacin (837) | Prednisone | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (cervical adenopathy and fever). MAC-IRIS resolved following approximately 4 mo of corticosteroid treatment. |
| 49 y, M | 2 (13) | FTC + TDF, ATV | CMV retinitis, HSV (perirectal), oral candidiasis, Candida esophagitis, baseline MAC | 93 | AFB blood culture grew MAC | Extensive abdominal lymphadenopathy (paradoxical IRIS) | Started 4 d before ART: • Azithromycin (341) • Ethambutol (808) • Moxifloxacin (467) | None | Briefly hospitalized for MAC-IRIS symptom management (abdominal pain and fever). MAC IRIS resolved without corticosteroids. |
| 45 y, M | 37 (124) | EFV + FTC + TDF | Oral candidiasis, CNS lymphoma | 14 | BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 19 d after ART: • Azithromycin (513) • Ethambutol (513) • Moxifloxacin (513) | Prednisolone | Hospitalized for 13 wk for CNS lymphoma, MAC-IRIS, and failure to thrive. Patient experienced sufficient recovery to allow for hospital discharge but died of sudden cardiac death at home 890 d after ART initiation. |
| 31 y, M | 4 (26) | ATV, FTC + TDF, RTV | Pneumocystis carinii pneumonia, HSV (rectal) | 14 | FNA of lymph node positive by AFB smear, BAL fluid grew MAC | Lymphadenopathy (unmasking IRIS) | Started 42 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (725) | Prednisone | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS recurred >2 y after initial diagnosis despite continuous ART and prolonged MAC treatment. |
| 44 y, M | 5 (119) | EFV + FTC + TDF | Pneumocystis carinii pneumonia | 21 | FNA of paratracheal lymph node positive for AFB by Fite stain, AFB culture of lymph node biopsy material grew MAC | Pulmonary (unmasking IRIS) | Started 48 d after ART: • Azithromycin (599) • Ethambutol (599) • Moxifloxacin (584) | None | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (fever, dry cough, and night sweats). MAC-IRIS resolved without corticosteroids. |
| 47 y, F | 3 (14) | EFV + FTC + TDF | Oral candidiasis, baseline MAC | 14 | AFB blood culture grew MAC | Extensive lymphadenopathy (paradoxical IRIS) | Started 42 d after ART: • Azithromycin (91) • Ethambutol (550) • Moxifloxacin (550) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, adenopathy, and tachycardia) provided through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 50 y, M | 25 (119) | EFV + FTC + TDF | Cryptococcal meningitis | 9 | AFB smear of material collected from FNA of abdominal mass positive; AFB culture of the fluid also grew MAC | Extensive mesenteric lymphadenopathy (unmasking IRIS) | Started 99 d after ART: • Azithromycin (86) • Ethambutol (72) • Rifabutin (86) | None | Extensive workup of MAC-IRIS presenting symptoms (weight loss with new abdominal mass on imaging) conducted primarily in the outpatient setting, with 2 brief hospitalizations. Diagnosis ultimately made following FNA of abdominal mass for AFB culture. MAC-IRIS resolved without corticosteroids. |
| 29 y, M | 29 (157) | RAL, FTC + TDF | None | 56 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 62 d after ART: • Azithromycin (611) • Ethambutol (611) • Moxifloxacin (611) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptom (pleuritic chest pain) provided with frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 39 y, M | 44 (178) | DRV, RAL, FTC + TDF | Strongyloides | 30 | Histologic diagnosis by granulomas on lung biopsy | Pulmonary (unmasking IRIS) | Started 71 d after ART: • Azithromycin (363) • Ethambutol (363) • Moxifloxacin (126) | None | Not hospitalized. Patient did not have clinical symptoms of MAC-IRIS; diagnostic workup revealing unmasking MAC-IRIS was prompted by newly positive PPD 4 wk after ART initiation. |
| 41 y, M | 35 (154) | EFV + FTC + TDF, RAL | Pneumocystis carinii pneumonia, CMV pneumonia | 32 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 42 d after ART: • Azithromycin (579) • Ethambutol (579) | None | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 37 y, F | 8 (11) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, HSV, oral candidiasis | 11 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 17 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (736) | Prednisone | Hospitalized for 10 d for diagnostic workup and management of MAC-IRIS symptoms in the setting of recent cancer treatment and neutropenia. MAC IRIS resolved. |
| Age and Sex . | CD4+ T-Cell Count at Baseline (at IRIS) . | ART Regimen . | Other OIs (Before or at the Time of MAC Diagnosis) . | Time to IRIS From ART Initiation, d . | MAC Diagnosis . | MAC-IRIS Presentation . | MAC Therapy, d . | Corticosteroids for MAC Treatment . | Hospitalizations and Outcome . |
|---|---|---|---|---|---|---|---|---|---|
| 47 y, M | 7 (97) | ABC + 3TC, ATV | Esophageal candidiasis, oral candidiasis, CMV enterocolitis, cryptosporidiosis | 99 | Liver, lymph node aspirates grew MAC | Lymphadenopathy (unmasking IRIS) | Started 107 d after ART: • Azithromycin (1461) • Ethambutol (1461) | Prednisone | Hospitalized for 12 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, diarrhea, and vomiting). MAC-IRIS resolved after treatment with corticosteroids. |
| 27 y, M | 40 (108) | FTC + TDF, ZDV, ATV + RTV | Pneumocystis carinii pneumonia, HSV (perianal), Kaposi sarcoma, oral candidiasis, oral hairy leukoplakia | 38 | Biopsy of abdominal lymph node positive for MAI | Lymphadenopathy (unmasking IRIS) | Started 60 d after ART: • Clarithromycin (965) • Ethambutol (965) | None | Hospitalized for 3 d for diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fevers, chills, myalgia, and vomiting). MAC-IRIS resolved without corticosteroids. |
| 48 y, F | 1 (48) | EFV + FTC + TDF | Pneumocystis carinii pneumonia, microsporidia, Cryptosporidium, oral candidiasis, genital/oral HSV | 18 | AFB blood culture grew MAC | Disseminated; high fever, hypotension, and tachycardia (unmasking IRIS) | Started 35 d after ART: • Azithromycin (141) • Ethambutol (141) • Moxifloxacin (140) | None | Hospitalized in ICU for 2 d for diagnostic workup of presenting MAC-IRIS symptoms (hypotension, tachycardia, fever). MAC-IRIS resolved without corticosteroids. |
| 25 y, M | 86 (488) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, oral candidiasis | 54 | Sputum positive for MAC by acid-fast stain, culture, and SecA1 PCR/sequencing | Pulmonary (unmasking IRIS) | Started 65 d after ART: • Azithromycin (495) • Ethambutol (495) • Moxifloxacin (495) | None | Briefly hospitalized for diagnostic workup of presenting MAC-IRIS symptoms (cough in the setting of new pulmonary lesions). MAC-IRIS resolved without corticosteroids. |
| 32 y, F | 5 (12) | ATV, FTC + TDF | Disseminated histoplasmosis, Strongyloides, toxoplasmosis, HSV (rectal), CMV viremia, baseline MAC | 44 | AFB blood culture grew MAC | Cervical lymphadenopathy (paradoxical IRIS) | Started 3 d before ART • Azithromycin (172) • Ethambutol (837) • Moxifloxacin (837) | Prednisone | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (cervical adenopathy and fever). MAC-IRIS resolved following approximately 4 mo of corticosteroid treatment. |
| 49 y, M | 2 (13) | FTC + TDF, ATV | CMV retinitis, HSV (perirectal), oral candidiasis, Candida esophagitis, baseline MAC | 93 | AFB blood culture grew MAC | Extensive abdominal lymphadenopathy (paradoxical IRIS) | Started 4 d before ART: • Azithromycin (341) • Ethambutol (808) • Moxifloxacin (467) | None | Briefly hospitalized for MAC-IRIS symptom management (abdominal pain and fever). MAC IRIS resolved without corticosteroids. |
| 45 y, M | 37 (124) | EFV + FTC + TDF | Oral candidiasis, CNS lymphoma | 14 | BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 19 d after ART: • Azithromycin (513) • Ethambutol (513) • Moxifloxacin (513) | Prednisolone | Hospitalized for 13 wk for CNS lymphoma, MAC-IRIS, and failure to thrive. Patient experienced sufficient recovery to allow for hospital discharge but died of sudden cardiac death at home 890 d after ART initiation. |
| 31 y, M | 4 (26) | ATV, FTC + TDF, RTV | Pneumocystis carinii pneumonia, HSV (rectal) | 14 | FNA of lymph node positive by AFB smear, BAL fluid grew MAC | Lymphadenopathy (unmasking IRIS) | Started 42 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (725) | Prednisone | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS recurred >2 y after initial diagnosis despite continuous ART and prolonged MAC treatment. |
| 44 y, M | 5 (119) | EFV + FTC + TDF | Pneumocystis carinii pneumonia | 21 | FNA of paratracheal lymph node positive for AFB by Fite stain, AFB culture of lymph node biopsy material grew MAC | Pulmonary (unmasking IRIS) | Started 48 d after ART: • Azithromycin (599) • Ethambutol (599) • Moxifloxacin (584) | None | Hospitalized for 3 d for diagnostic workup of presenting MAC-IRIS symptoms (fever, dry cough, and night sweats). MAC-IRIS resolved without corticosteroids. |
| 47 y, F | 3 (14) | EFV + FTC + TDF | Oral candidiasis, baseline MAC | 14 | AFB blood culture grew MAC | Extensive lymphadenopathy (paradoxical IRIS) | Started 42 d after ART: • Azithromycin (91) • Ethambutol (550) • Moxifloxacin (550) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptoms (fever, adenopathy, and tachycardia) provided through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 50 y, M | 25 (119) | EFV + FTC + TDF | Cryptococcal meningitis | 9 | AFB smear of material collected from FNA of abdominal mass positive; AFB culture of the fluid also grew MAC | Extensive mesenteric lymphadenopathy (unmasking IRIS) | Started 99 d after ART: • Azithromycin (86) • Ethambutol (72) • Rifabutin (86) | None | Extensive workup of MAC-IRIS presenting symptoms (weight loss with new abdominal mass on imaging) conducted primarily in the outpatient setting, with 2 brief hospitalizations. Diagnosis ultimately made following FNA of abdominal mass for AFB culture. MAC-IRIS resolved without corticosteroids. |
| 29 y, M | 29 (157) | RAL, FTC + TDF | None | 56 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 62 d after ART: • Azithromycin (611) • Ethambutol (611) • Moxifloxacin (611) | None | Not hospitalized; diagnostic workup and supportive care for presenting MAC-IRIS symptom (pleuritic chest pain) provided with frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 39 y, M | 44 (178) | DRV, RAL, FTC + TDF | Strongyloides | 30 | Histologic diagnosis by granulomas on lung biopsy | Pulmonary (unmasking IRIS) | Started 71 d after ART: • Azithromycin (363) • Ethambutol (363) • Moxifloxacin (126) | None | Not hospitalized. Patient did not have clinical symptoms of MAC-IRIS; diagnostic workup revealing unmasking MAC-IRIS was prompted by newly positive PPD 4 wk after ART initiation. |
| 41 y, M | 35 (154) | EFV + FTC + TDF, RAL | Pneumocystis carinii pneumonia, CMV pneumonia | 32 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 42 d after ART: • Azithromycin (579) • Ethambutol (579) | None | Not hospitalized; diagnostic workup and MAC-IRIS symptoms monitored through frequent outpatient visits. MAC-IRIS resolved without corticosteroids. |
| 37 y, F | 8 (11) | EFV + FTC + TDF | Diffuse large B-cell lymphoma, HSV, oral candidiasis | 11 | AFB culture of BAL fluid grew MAC | Pulmonary (unmasking IRIS) | Started 17 d after ART: • Azithromycin (736) • Ethambutol (736) • Moxifloxacin (736) | Prednisone | Hospitalized for 10 d for diagnostic workup and management of MAC-IRIS symptoms in the setting of recent cancer treatment and neutropenia. MAC IRIS resolved. |
Abbreviations: 3TC, lamivudine; ABC, abacavir; AFB, acid-fast bacilli; ART, antiretroviral therapy; ATV, atazanavir; BAL, bronchoalveolar lavage; CMV, cytomegalovirus; CNS, central nervous system; DRV, darunavir; EFV, efavirenz; F, female; FNA, fine needle aspiration; FTC, emtricitabine; HSV, herpes simplex virus; ICU, intensive care unit; IRIS, immune reconstitution inflammatory syndrome; M, male; MAI, Mycobacterium avium intracellulare; MAC, Mycobacterium avium complex; OI, opportunistic infection; PCR, polymerase chain reaction; PPD, purified protein derivative;; RAL, raltegravir; RTV, ritonavir; TDF, tenofovir; ZDV, zidovudine.
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