PMID- 19417581
OWN - NLM
STAT- MEDLINE
DCOM- 20090805
LR  - 20211020
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Print)
IS  - 0269-9370 (Linking)
VI  - 23
IP  - 9
DP  - 2009 Jun 1
TI  - Immune reconstitution inflammatory syndrome among HIV-infected South African 
      infants initiating antiretroviral therapy.
PG  - 1097-107
LID - 10.1097/QAD.0b013e32832afefc [doi]
AB  - OBJECTIVES: To determine the incidence, clinical manifestations and risk factors 
      for immune reconstitution inflammatory syndrome (IRIS) in young children 
      initiating highly active antiretroviral therapy (HAART). DESIGN: A prospective 
      cohort of antiretroviral-naive HIV-infected children less than 24 months of age 
      enrolled in a treatment strategies trial in Johannesburg, South Africa. METHODS: 
      Among 169 HIV-infected children initiating HAART, April 2005 to November 2006, 
      the records of 83 children suspected to have IRIS within 6 months of starting 
      treatment were reviewed to determine whether they met criteria for IRIS. Seven 
      were excluded due to incomplete follow-up. Pretreatment and post-treatment 
      characteristics of children with and without IRIS were compared. RESULTS: 
      Overall, 34/162 (21%) children developed IRIS at a median of 16 days (range 7-115 
      days) post-HAART initiation. Bacille Calmette-Guerin reaction was most common 
      occurring in 24/34 (71%) children, primarily injection site lesions and/or 
      ipsilateral axillary lymphadenitis with abscess. Other IRIS conditions (not 
      mutually exclusive) included Mycobacterium tuberculosis (n = 12), cytomegalovirus 
      pneumonia (n = 1), Streptococcus pneumonia sepsis (n = 1), and severe seborrheic 
      dermatitis (n = 1). Children with IRIS were younger (median age 7 vs. 10 months, 
      P = 0.007) with a lower CD4 cell percentage (median 13.9 vs. 19.2, P = 0.009) at 
      HAART initiation than controls. After 24 weeks on HAART, 62% of IRIS cases vs. 
      28% of controls had HIV RNA more than 400 copies/ml (P = 0.001), odds ratio = 
      2.88 (95% confidence interval = 1.14-7.29) after adjusting for baseline factors. 
      CONCLUSION: Infants and young children with advanced HIV disease initiating HAART 
      are at high risk for developing IRIS, leading to additional morbidity and 
      possibly impairing virologic response to antiretroviral treatment.
FAU - Smith, Kelly
AU  - Smith K
AD  - Columbia University College of Physicians & Surgeons, New York, New York, USA.
FAU - Kuhn, Louise
AU  - Kuhn L
FAU - Coovadia, Ashraf
AU  - Coovadia A
FAU - Meyers, Tammy
AU  - Meyers T
FAU - Hu, Chih-Chi
AU  - Hu CC
FAU - Reitz, Cordula
AU  - Reitz C
FAU - Barry, Gillian
AU  - Barry G
FAU - Strehlau, Renate
AU  - Strehlau R
FAU - Sherman, Gayle
AU  - Sherman G
FAU - Abrams, Elaine J
AU  - Abrams EJ
LA  - eng
GR  - R01 HD047177-04/HD/NICHD NIH HHS/United States
GR  - R01 HD047177-01A1/HD/NICHD NIH HHS/United States
GR  - R01 HD047177/HD/NICHD NIH HHS/United States
GR  - R01 HD047177-05/HD/NICHD NIH HHS/United States
GR  - R01 HD047177-02/HD/NICHD NIH HHS/United States
GR  - HD 47177/HD/NICHD NIH HHS/United States
GR  - R01 HD047177-03/HD/NICHD NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (BCG Vaccine)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*chemically induced/immunology
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - BCG Vaccine/*adverse effects
MH  - CD4 Lymphocyte Count
MH  - CD4-Positive T-Lymphocytes/virology
MH  - Female
MH  - HIV-1/*immunology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*chemically induced/immunology
MH  - Infant
MH  - Male
MH  - Prospective Studies
MH  - Risk Factors
MH  - South Africa
MH  - Viral Load
PMC - PMC2810152
MID - NIHMS164877
EDAT- 2009/05/07 09:00
MHDA- 2009/08/06 09:00
PMCR- 2010/01/22
CRDT- 2009/05/07 09:00
PHST- 2009/05/07 09:00 [entrez]
PHST- 2009/05/07 09:00 [pubmed]
PHST- 2009/08/06 09:00 [medline]
PHST- 2010/01/22 00:00 [pmc-release]
AID - 10.1097/QAD.0b013e32832afefc [doi]
PST - ppublish
SO  - AIDS. 2009 Jun 1;23(9):1097-107. doi: 10.1097/QAD.0b013e32832afefc.