A prospective study of the immune reconstitution inflammatory syndrome (IRIS) in HIV-infected children from high prevalence countries

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dc.contributor.authorCotton, Mark F.en_ZA
dc.contributor.authorRabie, Helenaen_ZA
dc.contributor.authorNemes, Elisaen_ZA
dc.contributor.authorMujuru, Hildaen_ZA
dc.contributor.authorBobat, Raziyaen_ZA
dc.contributor.authorNjau, Bonifaceen_ZA
dc.contributor.authorViolari, Avyen_ZA
dc.contributor.authorMave, Vidyaen_ZA
dc.contributor.authorMitchell, Charlesen_ZA
dc.contributor.authorOleske, Jamesen_ZA
dc.contributor.authorZimmer, Bonnieen_ZA
dc.contributor.authorVarghese, Georgeen_ZA
dc.contributor.authorPahwa, Savitaen_ZA
dc.date.accessioned2021-06-29T06:27:26Z
dc.date.available2021-06-29T06:27:26Z
dc.date.issued2019-07-01
dc.descriptionCITATION: 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.
dc.descriptionThe original publication is available at https://journals.plos.org/plosone
dc.description.abstractBackground: 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.en_ZA
dc.description.versionPublisher's version
dc.format.extent17 pagesen_ZA
dc.identifier.citationCotton, 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.
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0211155
dc.identifier.urihttp://hdl.handle.net/10019.1/110621
dc.language.isoen_ZAen_ZA
dc.publisherPLoSen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectImmune reconstitution inflammatory syndrome (IRIS)en_ZA
dc.subjectHIV-positive childrenen_ZA
dc.subjectOpportunistic infectionsen_ZA
dc.subjectAntiretroviral agentsen_ZA
dc.titleA prospective study of the immune reconstitution inflammatory syndrome (IRIS) in HIV-infected children from high prevalence countriesen_ZA
dc.typeArticleen_ZA
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