Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in children.

Abstract

BACKGROUND:

Paradoxical tuberculosis (TB)-associated Immune Reconstitution Inflammatory Syndrome (IRIS) is a common complication of combination antiretroviral treatment (cART) initiation in adults residing in resource-limited regions. Little is known about the burden and presentation of TB-IRIS in children initiating cART while receiving TB treatment.

METHODS:

Prospective cohort study of South African children initiating cART while on TB treatment. Children were assessed clinically and by chest x-ray before starting cART and at 2, 4, 6, and 12 weeks post cART initiation. All children who presented with any signs or symptoms suggestive of paradoxical TB-IRIS were classified according to the consensus adult TB-IRIS case definition developed by the International Network for Study of HIV-associated IRIS (INSHI) and reviewed by an independent expert panel.

RESULTS:

In 7 of the 104 children enrolled in the cohort, symptoms and/or clinical or radiological signs suggestive of paradoxical TB-IRIS developed after a median of 14 days of cART. In two of these cases, there was agreement between the INSHI case definition and the expert panel. In an additional 3 cases, the INSHI criteria were fulfilled but the expert panel made an alternative diagnosis of pneumonia (n = 2) and poor adherence to cART (n = 1).

CONCLUSIONS:

The burden of paradoxical TB-IRIS in children with underlying TB initiating cART is low. Including response to antibiotic treatment for pneumonia as a criterion for an alternative diagnosis may improve the specificity of the INSHI case definition.

• Authors: Annelies Van Rie, Shobna Sawry, Ruth Link-Gelles, Shabir Madhi, Lee Fairlie, Charl Verwey, Nasreen Mahomed, David Murdoch, Harry Moultrie
• Journal: Pediatric pulmonology (Pediatr Pulmonol) Vol. 51 Issue 2 Pg. 157-64 (Feb 2016) ISSN: 1099-0496 [Electronic] United States
• PMID: 26073306 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: © 2015 Wiley Periodicals, Inc.

Chemical References

• Antitubercular Agents
• HIV Protease Inhibitors
• Lopinavir
• Ritonavir

Topics

• Antiretroviral Therapy, Highly Active
• Antitubercular Agents (therapeutic use)
• Child
• Child, Preschool
• Cohort Studies
• Female
• HIV Infections (complications, drug therapy)
• HIV Protease Inhibitors (adverse effects)
• Humans
• Immune Reconstitution Inflammatory Syndrome (chemically induced, immunology)
• Infant
• Infant, Newborn
• Lopinavir (adverse effects)
• Male
• Prospective Studies
• Ritonavir (adverse effects)
• South Africa
• Tuberculosis (drug therapy, immunology)
• Tuberculosis, Lymph Node (drug therapy, immunology)
• Tuberculosis, Pulmonary (drug therapy, immunology)