title: Varicella zoster as a manifestation of immune restoration disease in HIV-infected children.
abstract: BACKGROUND
  Exacerbation of opportunistic infections in HIV-infected patients shortly after initiation of highly active antiretroviral therapy (HAART) has been named immune restoration disease (IRD). Thus far, IRD has not been reported in children.
  
  
  OBJECTIVE
  We describe the clinical and immune characteristics of IRD in HIV-infected children treated with HAART.
  
  
  METHODS
  A historical cohort study was conducted in a tertiary HIV center in perinatally HIV-infected children who were started on a first stable HAART between January 1996 and July 2002. The incidence of opportunistic infections, newly AIDS-defining events or death after initiation of HAART, and virologic and immunologic information was evaluated at baseline and every 3 months post-HAART.
  
  
  RESULTS
  Sixty-one perinatally HIV-infected children were started and maintained on HAART for >6 months. Seven episodes of IRD occurred. All were cutaneous herpes zoster (HZ). Children who developed HZ had significantly lower baseline CD4+ and CD8+ T-cell numbers compared with children who did not. HZ occurred only in children (7 of 34 subjects) with virological and immunological success to HAART. In children with a previous history of varicella infection, the risk of developing HZ after HAART was higher in those without a protective level of varicella-specific IgG (50%, or 5 of 10 subjects) compared with those with seroprotection (10%, or 2 of 20).
  
  
  CONCLUSIONS
  Herpes zoster is a common manifestation of IRD in HIV-infected children after the initiation of HAART. Risks for developing HZ include no protective varicella-specific antibody despite previous varicella infection, severe immunodeficiency at baseline, and vigorous immunologic and virologic responses to HAART.
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, University of South Florida/All Children's Hospital, 801 Sixth Street South, Box 9350, St Petersburg, FL 33701, USA. tangsinn@allkids.org
authors.forename: Nutthapong
authors.initials: N
authors.lastname: Tangsinmankong
authors.forename: Wasu
authors.initials: W
authors.lastname: Kamchaisatian
authors.forename: Jorge
authors.initials: J
authors.lastname: Lujan-Zilbermann
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Brown
authors.forename: John W
authors.initials: JW
authors.lastname: Sleasman
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Emmanuel
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006562:Herpes Zoster / Q000209:etiology* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000502:physiology; D006801:Humans; D008297:Male; D009894:Opportunistic Infections / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014775:Virus Activation