Department of Pediatrics, School of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
Pediatr Infect Dis J. 2009 Oct;28(10):900-3. doi: 10.1097/INF.0b013e3181a4b7fa.
Immune reconstitution inflammatory syndrome (IRIS) after initiating highly active antiretroviral therapy (HAART) has not been widely studied in children, especially in resource-poor settings.
Retrospective cohort study of HIV-infected children initiating HAART between 2001 and 2006 at a tertiary pediatric hospital in Lima, Peru. Charts were reviewed for 1 year after HAART initiation. IRIS was defined as a HAART-associated adverse event caused by an infectious or inflammatory condition in patients with documented virologic or immunologic success.
Ninety-one children (52% female) received HAART for at least 1 year. Median age at initiation was 5.7 years; 91% were ART naive and 73% had CDC stage C disease. The incidence of IRIS was 19.8 events per 100 person years (95% CI: 11.5-28.0). Median time to IRIS was 6.6 weeks after HAART initiation (range: 2-32 weeks). There were 18 IRIS events, 11 unmasking and 7 paradoxical. These included associations with Mycobacterium tuberculosis in 4 cases, Bacillus Calmette Guerin lymphadenitis in 1 case, varicella zoster virus in 6 cases and herpes simplex labialis in 6 cases. Children who developed IRIS had a higher baseline HIV viral load (P = 0.02) and an indicator of malnutrition (P = 0.007) before HAART initiation.
IRIS occurred in 20% of HIV-infected children starting HAART in Peru and was associated with more advanced disease and malnutrition. Future research is needed to examine specific risk factors associated with pediatric IRIS to allow prompt identification and treatment of IRIS.
在开始高效抗逆转录病毒治疗（HAART）后，免疫重建炎症综合征（IRIS）在儿童中并未得到广泛研究，尤其是在资源匮乏的环境中。
这是一项在秘鲁利马的一家三级儿科医院进行的 HIV 感染儿童开始 HAART 的回顾性队列研究。在 HAART 开始后 1 年内对图表进行了回顾。IRIS 被定义为在有记录的病毒学或免疫学成功的患者中，由感染或炎症引起的与 HAART 相关的不良事件。
91 名儿童（52%为女性）接受了至少 1 年的 HAART。起始年龄中位数为 5.7 岁；91%为初次接受 ART 治疗，73%为疾病控制和预防中心（CDC）分期 C 期疾病。IRIS 的发生率为每 100 人年 19.8 例（95%CI：11.5-28.0）。从 HAART 开始到 IRIS 的中位时间为 6.6 周（范围：2-32 周）。共发生 18 例 IRIS 事件，11 例为未掩蔽事件，7 例为矛盾事件。其中包括 4 例与结核分枝杆菌相关、1 例卡介苗淋巴结炎、6 例水痘带状疱疹病毒和 6 例单纯疱疹性唇炎。发生 IRIS 的儿童在开始 HAART 前的 HIV 病毒载量更高（P = 0.02），并且有营养不良的指标（P = 0.007）。
在秘鲁开始 HAART 的 HIV 感染儿童中有 20%发生了 IRIS，与更晚期的疾病和营养不良有关。需要进一步研究以探讨与儿科 IRIS 相关的特定危险因素，以便及时识别和治疗 IRIS。
