A prospective study of the immune reconstitution inflammatory syndrome (IRIS) in HIV-infected children from high prevalence countries
Date
2019-07-01
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS
Abstract
Background: The immune reconstitution inflammatory syndrome (IRIS) in HIV-infected infants and young
children is relatively understudied in regions endemic for HIV and TB. We aimed to describe
incidence, clinical features and risk factors of pediatric IRIS in Sub-Saharan Africa and
India. Methods and findings: We conducted an observational multi-centred prospective clinical study from December 2010 to September 2013 in children <72 months of age recruited from public antiretroviral
programs. The main diagnostic criterion for IRIS was a new or worsening inflammatory
event after initiating antiretroviral therapy (ART). Among 198 participants, median age 1.15
(0.48; 2.21) years, 38 children (18.8%) developed 45 episodes of IRIS. Five participants
(13.2%) had two IRIS events and one (2.6%) had 3 events. Main causes of IRIS were BCG
(n = 21; 46.7%), tuberculosis (n = 10; 22.2%) and dermatological, (n = 8, 17.8%). Four TB
IRIS cases had severe morbidity including 1 fatality. Cytomegalovirus colitis and cryptococcal meningitis IRIS were also severe. BCG IRIS resolved without pharmacological intervention. On multivariate logistic regression, the most important baseline associations with IRIS were high HIV viral load (likelihood ratio [LR] 10.629; p = 0.0011), recruitment at 1 site (Stellenbosch University) (LR 4.01; p = 0.0452) and CD4 depletion (LR 3.4; p = 0.0654). Significantly more non-IRIS infectious and inflammatory events between days 4 and 17 of ART
initiation were noted in cases versus controls (35% versus 15.2%: p = 0.0007).
Conclusions: IRIS occurs commonly in HIV-infected children initiating ART and occasionally has severe
morbidity. The incidence may be underestimated. Predictive, diagnostic and prognostic biomarkers are needed.
Description
CITATION: Cotton, M. F. et al 2019. A prospective study of the immune reconstitution inflammatory syndrome (IRIS) in HIV-infected children from high prevalence countries. PLoS ONE, 14(7): e0211155, doi:10.1371/journal.pone.0211155.
The original publication is available at https://journals.plos.org/plosone
The original publication is available at https://journals.plos.org/plosone
Keywords
Immune reconstitution inflammatory syndrome (IRIS), HIV-positive children, Opportunistic infections, Antiretroviral agents
Citation
Cotton, M. F. et al 2019. A prospective study of the immune reconstitution inflammatory syndrome (IRIS) in HIV-infected children from high prevalence countries. PLoS ONE, 14(7): e0211155, doi:10.1371/journal.pone.0211155.