Link-Gelles Ruth, Moultrie Harry, Sawry Shobna, Murdoch David, Van Rie Annelies
From the *Department of Epidemiology, University of North Carolina, Chapel Hill, NC; †Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; and ‡Duke University Medical Center, Durham, NC.
Pediatr Infect Dis J. 2014 May;33(5):499-503. doi: 10.1097/INF.0000000000000142.
People with HIV initiating combination antiretroviral therapy are at risk for tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS). While this syndrome has been well researched in adults, little is known about the incidence, case fatality, underlying immunopathology and treatment approaches in children.
Major databases were searched for articles related to TB-IRIS in children. Data were abstracted using standardized forms.
Thirteen studies were identified: 6 retrospective and 2 prospective cohort studies, 1 cross-sectional study, 3 case reports and 1 case series. In total, 303 cases of TB-IRIS were described, of which 270 were unmasking TB-IRIS, 12 paradoxical TB-IRIS and 21 were not classifiable due to lack of key information. None of the cohort studies had investigation of TB-IRIS as its primary aim. Nine studies were from Africa, 3 from Asia and 1 from Latin America. Age at cART initiation (reported by 12 studies) ranged from 1 month to 16 years. Median time from start of cART to IRIS diagnosis (reported by 8 studies) ranged from 8 days to 16 weeks. Few deaths attributable to TB-IRIS were recorded. Treatment was only discussed in 2 case studies, both of which reported children receiving corticosteroids. No studies evaluated risk factors for, or immunopathogenesis of, pediatric TB-IRIS.
There is a paucity of information available on TB-IRIS in children. Future research assessing incidence, risk factors, case fatality and optimal treatment or prevention strategies of TB-IRIS is needed.
开始接受抗逆转录病毒联合疗法的艾滋病毒感染者有患结核病相关免疫重建炎症综合征（TB-IRIS）的风险。虽然该综合征在成人中已得到充分研究，但对于儿童的发病率、病死率、潜在免疫病理学及治疗方法知之甚少。
检索主要数据库中与儿童TB-IRIS相关的文章。使用标准化表格提取数据。
共确定了13项研究：6项回顾性研究、2项前瞻性队列研究、1项横断面研究、3例病例报告和1个病例系列。总共描述了303例TB-IRIS病例，其中270例为揭露性TB-IRIS，12例为矛盾性TB-IRIS，21例因缺乏关键信息而无法分类。没有一项队列研究将TB-IRIS作为其主要研究目的。9项研究来自非洲，3项来自亚洲，1项来自拉丁美洲。开始接受抗逆转录病毒治疗时的年龄（12项研究报告）为1个月至16岁。从开始抗逆转录病毒治疗到IRIS诊断的中位时间（8项研究报告）为8天至16周。记录到的由TB-IRIS导致的死亡很少。仅在2项病例研究中讨论了治疗，这两项研究均报告儿童接受了皮质类固醇治疗。没有研究评估儿童TB-IRIS的危险因素或免疫发病机制。
关于儿童TB-IRIS的信息匮乏。需要开展未来研究以评估TB-IRIS的发病率、危险因素、病死率以及最佳治疗或预防策略。
