Caracterización del síndrome inflamatorio de reconstitución inmune en una cohorte mexicana
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Palabras clave
VIH, Síndrome Inflamatorio de Reconstitución Inmune, Infecciones Oportunistas, Antirretrovirales
Resumen
Introducción: el síndrome inflamatorio de reconstitución inmune (SIRI) es una respuesta inflamatoria exagerada frente a patógenos oportunistas que previamente infectaron al paciente, caracterizada por un deterioro clínico durante los primeros meses tras iniciar la terapia antirretroviral, y que contribuye a la morbimortalidad en personas que viven con VIH (PVVIH). En México, la información al respecto es limitada; sin embargo, se ha reportado una frecuencia de 11.4–27%, con varicela zóster como el agente más asociado y una mortalidad de 4.9 muertes por 100 personas-año.
Objetivo: describir las características clínicas y etiológicas del SIRI en pacientes atendidos en un hospital de tercer nivel en México.
Material y métodos: estudio transversal retrospectivo, con revisión de expedientes del Hospital de Especialidades del Centro Médico Nacional Siglo XXI, en pacientes con diagnóstico reciente de VIH, del 1 de enero de 2017 al 31 de junio de 2023. Las variables se registraron y analizaron con SPSS versión 25, considerando significancia estadística con p < 0.05.
Resultados: se incluyeron 55 pacientes; 45 (81.81%) presentaron SIRI desenmascarado. El tiempo de presentación posterior al inicio de la terapia antirretroviral fue de 6 (4–12) semanas. M. tuberculosis fue el agente más frecuente, con 15 casos (27.27%). Se registraron 8 defunciones (14.54%), asociadas a neumonía por Pneumocystis y toxoplasmosis cerebral. El uso de esteroides se asoció con mayor mortalidad.
Conclusiones: los microorganismos más frecuentemente asociados a SIRI fueron M. tuberculosis y el citomegalovirus. La letalidad observada fue del 14.54%, superior a la reportada en otras series en México.
Referencias
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