PMID- 31355171
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2296-2360 (Print)
IS  - 2296-2360 (Electronic)
IS  - 2296-2360 (Linking)
VI  - 7
DP  - 2019
TI  - An Exclusively Skewed Distribution of Pediatric Immune Reconstitution 
      Inflammatory Syndrome Toward the Female Sex Is Associated With Advanced Acquired 
      Immune Deficiency Syndrome.
PG  - 293
LID - 10.3389/fped.2019.00293 [doi]
LID - 293
AB  - In human immunodeficiency virus and acquired immune deficiency syndrome 
      (HIV/AIDS) patients with very low CD4 cell counts, there is a temporal 
      relationship between administration of antiretroviral therapy (ART) and an 
      increased inflammatory response state known as the immune reconstitution 
      inflammatory syndrome (IRIS). The predominant clinical presentation of IRIS is an 
      infectious disease that can be life-threatening. IRIS-related infectious events 
      are distributed similarly between adult males and females, albeit a few studies 
      have shown a skewing toward the male sex in pediatric IRIS. Here, we assessed 
      sex-specific differences in the causes and extent of IRIS infectious events in 
      HIV-infected pediatric patients on ART. We carried out a prospective clinical 
      analysis (from 2000 to 2018) of IRIS-related infectious events after ART in a 
      cohort of 82 Brazilian children and adolescents infected with HIV-1 through 
      mother-to-child transmission as well as a comprehensive cross-referencing with 
      public records on IRIS-related infectious causes in pediatric HIV/AIDS. Twelve 
      events fulfilling the criteria of IRIS occurred exclusively in 11 females in our 
      cohort. The median age at IRIS events was 3.6 years. The infectious causes 
      included Mycobacterium bovis, varicella-zoster virus, molluscum contagiosum 
      virus, human papillomavirus, cytomegalovirus, and Mycobacterium tuberculosis. In 
      one female, there was regional bacillus Calmette-Guerin dissemination and 
      cytomegalovirus esophagitis. There was complete health recovery after 10 IRIS 
      events without the use of corticosteroids or ART interruption. One case of 
      IRIS-associated miliary tuberculosis was fatal. The biological female sex was a 
      significant risk factor for IRIS events (odds ratio: 23.67; 95% confidence 
      interval 95%: 1.341-417.7; P = 0.0016 and P < 0.01 by the multivariable 
      analysis). We observed an effect of the advanced HIV/AIDS variable in IRIS 
      females as compared with non-IRIS females (mean CD4(+) T cell percentage 13.36 
      vs. 18.63%; P = 0.0489 and P < 0.05 by the multivariable analysis), underpinning 
      the exclusively skewed distribution toward the female sex of this cohort. 
      Moreover, the IRIS females in our cohort had higher mean CD4(+) T cell 
      percentages before (13.36%) and after IRIS (26.56%) than those of the IRIS 
      females (before IRIS, 4.978%; after IRIS, 13.81%) in previous studies conducted 
      worldwide. The exclusively skewed distribution of pediatric IRIS toward the 
      female sex in the cohort was not linked to preferential X-chromosome inactivation 
      rates. We concluded that the exclusively skewed distribution of pediatric IRIS 
      toward females is associated with more advanced AIDS.
FAU - de Souza Campos Fernandes, Regina Celia
AU  - de Souza Campos Fernandes RC
AD  - Faculty of Medicine of Campos, Campos dos Goytacazes, Brazil.
AD  - Municipal Program for the Surveillance of Sexually Transmitted Diseases and 
      Acquired Immunodeficiency Syndrome of Campos dos Goytacazes, Campos dos 
      Goytacazes, Brazil.
AD  - Molecular Identification and Diagnosis Unit, Laboratory of Biotechnology, Center 
      for Biosciences and Biotechnology, Universidade Estadual do Norte Fluminense 
      Darcy Ribeiro, Campos dos Goytacazes, Brazil.
FAU - Louvain de Souza, Thais
AU  - Louvain de Souza T
AD  - Faculty of Medicine of Campos, Campos dos Goytacazes, Brazil.
AD  - Molecular Identification and Diagnosis Unit, Laboratory of Biotechnology, Center 
      for Biosciences and Biotechnology, Universidade Estadual do Norte Fluminense 
      Darcy Ribeiro, Campos dos Goytacazes, Brazil.
FAU - da Silva Barcellos, Thiago
AU  - da Silva Barcellos T
AD  - Faculty of Medicine of Campos, Campos dos Goytacazes, Brazil.
FAU - Medina-Acosta, Enrique
AU  - Medina-Acosta E
AD  - Molecular Identification and Diagnosis Unit, Laboratory of Biotechnology, Center 
      for Biosciences and Biotechnology, Universidade Estadual do Norte Fluminense 
      Darcy Ribeiro, Campos dos Goytacazes, Brazil.
LA  - eng
PT  - Journal Article
DEP - 20190710
PL  - Switzerland
TA  - Front Pediatr
JT  - Frontiers in pediatrics
JID - 101615492
PMC - PMC6635464
OTO - NOTNLM
OT  - X-chromosome inactivation (XCI)
OT  - acquired immune deficiency syndrome (IRIS)
OT  - antiretroviral therapy (ART)
OT  - human immunodeficiency virus (HIV)
OT  - immune reconstitution inflammatory syndrome (IRIS)
OT  - skewed female sex ratio
EDAT- 2019/07/30 06:00
MHDA- 2019/07/30 06:01
PMCR- 2019/07/10
CRDT- 2019/07/30 06:00
PHST- 2019/01/07 00:00 [received]
PHST- 2019/06/28 00:00 [accepted]
PHST- 2019/07/30 06:00 [entrez]
PHST- 2019/07/30 06:00 [pubmed]
PHST- 2019/07/30 06:01 [medline]
PHST- 2019/07/10 00:00 [pmc-release]
AID - 10.3389/fped.2019.00293 [doi]
PST - epublish
SO  - Front Pediatr. 2019 Jul 10;7:293. doi: 10.3389/fped.2019.00293. eCollection 2019.