Incidence of Immune Reconstitution Inflammatory Syndrome in HIV Infected Children in Peru

1
Incidence of Immune Reconstitution Inflammatory
Syndrome in HIV Infected Children in Peru

• M.E. Wang1, M.E. Castillo2, J.R. Zunt3

1Stanford University School of Medicine,
Stanford, USA 2Instituto Nacional de Salud del
Niño, Infectious Diseases Service, Lima, Peru,
3University of Washington, Departments of
Neurology, Global Health and Medicine (Infectious
Diseases), Seattle, USA Research supported by
the NIH/Fogarty International Clinical Research
Scholars Program
2
Introduction

• IRIS Clinical deterioration due to an infectious
  or inflammatory response shortly after the start
  of HAART therapy, with concurrent immune recovery
• 10-32 incidence in adults, 19 in children

Methods

• Retrospective
• Population All children starting HAART at the
  Instituto Nacional de Salud del Niño, Peru,
  2002-06

• IRIS Definition Occurrence of a condition
  previously associated with IRIS within a year of
  starting HAART, in a patient with virologic or
  immunologic success

3
Results

• 91 patients evaluated
• 19.8 (18/91) of patients developed IRIS
• 33 of cases (6/18) from Mycobacterium spp.
• M. tuberculosis 5 cases
• BCG adenitis 1 case
• 33 of cases (6/18) from varicella zoster virus
• 33 of cases (6/18) from herpes simplex labialis
• All cases resolved, no IRIS related mortality
• Median time to onset 6.6 weeks (Range 2-34)
• 33 had a previous diagnosis with the IRIS
  infection
• 39 required hospitalization for IRIS

4
Results

• No significant differences between the IRIS and
  non-IRIS groups with regards to age, sex,
  treatment regimen, CDC disease stage, pre-HAART
  CD4 count
• Significant differences

Conclusions

• IRIS is a common occurrence in HIV-infected
  children starting HAART in Peru
• Incidence and range of causes was similar to
  those found in other studies
• Future studies should examine risk factors so
  patients more susceptible can be identified and
  treated promptly