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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Immune reconstitution inflammatory syndrome among HIV-infected South African infants initiating antiretroviral therapy
AIDS, Volume 23, No. 9, Year 2009
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Description
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-naïve 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-Guérin 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. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Smith, Kelly
United States, New York
Vagelos College of Physicians and Surgeons
Kuhn, Louise
United States, New York
Mailman School of Public Health
Coovadia, Ashraf Hassen
South Africa, Johannesburg
Coronation Women and Children Hospital
Meyers, Tammy M.M.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Hu, Chihchi
United States, New York
Mailman School of Public Health
Reitz, Cordula
United States, New York
Mailman School of Public Health
Barry, Gillian
South Africa, Johannesburg
Coronation Women and Children Hospital
Strehlau, Renate
South Africa, Johannesburg
Coronation Women and Children Hospital
Sherman, Gayle Gillian
South Africa, Johannesburg
University of the Witwatersrand
Abrams, Elaine J.
United States, New York
Vagelos College of Physicians and Surgeons
United States, New York
Mailman School of Public Health
Statistics
Citations: 85
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1097/QAD.0b013e32832afefc
e-ISSN:
14735571
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Case-Control Study
Study Locations
South Africa