Immune reconstitution inflammatory syndrome in the first 6 months of antiretroviral therapy in HIVin

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Immune reconstitution inflammatory syndrome in
the first 6 months of antiretroviral therapy in
HIV-infected Ugandan children.Presenter Jane
Achan

• Prospective observational study of 83 HIV
  infected children aged 1-10 years starting ART
  between October 2005 and November 2007 at Mulago
  Hospital in Uganda.
• Objectives were to
• Characterize the frequency of IRIS in this
  population
• Describe the clinical spectrum of IRIS events in
  this population
• Determine the predictors of IRIS in this
  population
• ART was initiated when indicated by WHO and
  national guidelines
• Participants were evaluated for IRIS events
  during the first 6 months following ART
  initiation.
• Participants seen monthly for follow-up visits
• IRIS was defined as a clinical deterioration from
  an infectious or inflammatory condition
  temporally related to the initiation of ART.
• (Boulware et al, Current Opinion in HIV and
  AIDS 2008)

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IRIS events seen in HIV infected children
completing 6 months of therapy

• Clinical outcomes
• 5 patients hospitalized (all with acute pulmonary
  syndrome)
• No deaths due to IRIS
• ART therapy was not interrupted due to IRIS

Predictors of IRIS
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Conclusion

• IRIS was common in the first 6 months of ART
• Seen in more than half of the patients
• Acute pulmonary syndrome was the predominant IRIS
  event followed by dermatologic manifestations
• Higher CD4 count increase at 2 weeks post ART
  initiation was associated with a greater risk of
  IRIS.
• There was a surprisingly low rate of TB IRIS in
  this population.