Elsy Estefania Pérez-Pedraza

Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory response to previously acquired opportunistic pathogens, causing clinical deterioration in the first months after starting antiretroviral therapy, contributing to morbidity and mortality in people living with HIV (PLHIV). In Mexico, data are limited, but IRIS has been reported in 11.4 - 27% of patients, with Varicella zoster as the most frequently associated pathogen and a mortality rate of 4.9 deaths per 100 person-years. To describe clinical and etiological characteristics of immune reconstitution inflammatory syndrome in patients treated at a tertiary care hospital in Mexico. A cross-sectional, retrospective study, through the review of medical records from the Hospital de Especialidades CMN Siglo XXI, including patients with recent HIV diagnosis between January 1, 2017, and June 31, 2023. Variables were recorded and analyzed using SPSS v.25, with p < 0.05 considered statistically significant. 55 patients were included; 45 (81.8%) presented unmasking IRIS, with a median onset time of 6 (4-12) weeks after starting ART. M. tuberculosis was the most frequent pathogen (27.3%). There were eight deaths (14.5%), due to pneumocystis pneumonia and cerebral toxoplasmosis. Corticosteroid use was associated with higher mortality. The most frequent pathogens associated with IRIS were M. tuberculosis and cytomegalovirus. The case-fatality rate was 14.5%, higher than that reported in other Mexican series.

Antiretroviral therapy (ART) is highly effective for treating HIV, but it is associated with metabolic alterations, such as insulin resistance (IR), which can be assessed using HOMA-IR, or using more accessible alternatives such as triglyceride-glucose (TG) index, which has been validated in Mexican population with a cut-off point of 4.68, with sensitivity of 96.5% and specificity of 85%. However, there are no studies analyzing the applicability and changes of the TG index after ART initiation in HIV-positive patients. To describe the frequency of IR using the TG index in HIV patients without previous treatment (naive) before and one year after starting ART. Comparative cross-sectional study. The Internal Medicine and Infectology Department records of patients recently diagnosed with HIV from a third-level hospital during 2010-2025 were reviewed. Biochemical, clinical, and anthropometric data were collected at baseline and one year after treatment initiation. Variables were recorded and analyzed blindly using SPSS, v. 25, with nonparametric statistics. It was considered significant a p with a < 0.05 value. 86 cases, 88.4% men, with a median age of 34.5 years (IQR 24-44.25), had a TG index of 4.70 (IQR 4.55-4.89) at baseline and 4.77 (IQR 4.63-4.89) at 1 year, with a statistically significant increase (p = 0.025). Out of patients with naive HIV and normal baseline TG index, 64% exhibited an elevation above the IR threshold (> 4.68) after one year of ART. In contrast, among those with an already elevated baseline TG index, 72% remained elevated after one year of treatment.