PMID- 20616700
OWN - NLM
STAT- MEDLINE
DCOM- 20110325
LR  - 20211020
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Print)
IS  - 0269-9370 (Linking)
VI  - 24
IP  - 13
DP  - 2010 Aug 24
TI  - The clinical pattern, prevalence, and factors associated with immune 
      reconstitution inflammatory syndrome in Ugandan children.
PG  - 2009-17
LID - 10.1097/QAD.0b013e32833b260a [doi]
AB  - OBJECTIVE: To determine clinical pattern, prevalence, and factors associated with 
      pediatric immune reconstitution inflammatory syndrome (IRIS) in Uganda. DESIGN: A 
      prospective, multicenter cross-sectional study. METHODS: We enrolled HIV-infected 
      children receiving antiretroviral therapy (ART) between 0.5 and 6 months duration 
      from December 2006 to October 2007 at three pediatric clinics in Uganda. Children 
      were evaluated for IRIS at a one-time study visit by a standardized pediatric 
      case definition. RESULTS: The IRIS prevalence was 38% [95% confidence interval 
      (CI) 31-46] among 162 children (57% female) with a median age of 6 years 
      (interquartile range 2.5-11 years). Of the IRIS events, 77% were unmasking of a 
      new opportunistic infection and 23% were probable paradoxical IRIS events toward 
      prior opportunistic infections. The majority of IRIS events (55%) occurred in the 
      first month of ART. The clinical events were diverse, with tuberculosis-IRIS 
      (29%) being the most frequent presentation. Independent risk factors for IRIS 
      were pre-ART CD4(+) cell percentage below 15% (odds ratio = 3.1, 95% CI 1.2-8.4, 
      P = 0.027), current CD8(+) cell absolute count below 1000 cells/microl (odds 
      ratio = 4.3, 95% CI 1.8-10.4, P = 0.001), male sex (odds ratio = 2.6, 95% CI 
      1.06-8.4, P = 0.01), and a cough of more than 1 week duration at the current 
      clinic visit (odds ratio = 4.3, 95% CI 1.7-10.7, P = 0.002). A more than 25 
      CD4(+) T-cells increase at current study visit from the pre-ART baseline was 
      associated with IRIS by univariate (P = 0.005) but not multivariate analysis. 
      CONCLUSION: IRIS events commonly occur early after ART initiation in children 
      with advanced immunosuppression, as commonly seen in resource-limited areas. Both 
      healthcare providers and caregivers of the children need awareness of IRIS to 
      minimize ART nonadherence.
FAU - Orikiiriza, Judy
AU  - Orikiiriza J
AD  - Department of Pediatrics and Child Health, Makerere University College of Health 
      Sciences and Mulago National Referral Hospital, Uganda. jtatorichdr@yahoo.com
FAU - Bakeera-Kitaka, Sabrina
AU  - Bakeera-Kitaka S
FAU - Musiime, Victor
AU  - Musiime V
FAU - Mworozi, Edison A
AU  - Mworozi EA
FAU - Mugyenyi, Peter
AU  - Mugyenyi P
FAU - Boulware, David R
AU  - Boulware DR
LA  - eng
GR  - K23 AI073192-01A2/AI/NIAID NIH HHS/United States
GR  - L30 AI066779/AI/NIAID NIH HHS/United States
GR  - L30 AI066779-03/AI/NIAID NIH HHS/United States
GR  - K23AI073192-01A2/AI/NIAID NIH HHS/United States
GR  - K23 AI073192/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
SB  - IM
MH  - AIDS-Related Opportunistic Infections/epidemiology/*immunology/virology
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - CD4 Lymphocyte Count
MH  - Child
MH  - Child, Preschool
MH  - Cross-Sectional Studies
MH  - Female
MH  - HIV Infections/drug therapy/epidemiology/*immunology
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/epidemiology/*immunology/virology
MH  - Incidence
MH  - Male
MH  - Medication Adherence/statistics & numerical data
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Uganda/epidemiology
PMC - PMC2914829
MID - NIHMS214384
COIS- Conflicts of Interest: No conflicts of interest exist.
EDAT- 2010/07/10 06:00
MHDA- 2011/03/26 06:00
PMCR- 2011/08/24
CRDT- 2010/07/10 06:00
PHST- 2010/07/10 06:00 [entrez]
PHST- 2010/07/10 06:00 [pubmed]
PHST- 2011/03/26 06:00 [medline]
PHST- 2011/08/24 00:00 [pmc-release]
AID - 10.1097/QAD.0b013e32833b260a [doi]
PST - ppublish
SO  - AIDS. 2010 Aug 24;24(13):2009-17. doi: 10.1097/QAD.0b013e32833b260a.