title: Immune reconstitution syndrome after highly active antiretroviral therapy in human immunodeficiency virus-infected thai children.
abstract: BACKGROUND
  There is little information about the immune reconstitution syndrome (IRS) in children, especially from resource-poor countries.
  
  
  OBJECTIVE
  To determine the incidence and spectrum of IRS in advanced stage human immunodeficiency virus (HIV)-infected children after initiation of highly active antiretroviral therapy (HAART).
  
  
  METHODS
  Between May 2002 and April 2004, 153 symptomatic HIV-infected children who had CD4 lymphocyte percentage < or =15% initiated HAART in a national antiretroviral drug access program. All patients were followed for 48 weeks. In this study, IRS was defined as a disease event caused by microorganisms or conditions previously reported to be associated with IRS in patients having immunologic and/or virologic response to HAART.
  
  
  RESULTS
  The incidence of IRS was 19% (95% confidence interval, 13.1-26.1). The median time of onset was 4 weeks after start of HAART (range, 2-31). There were 32 episodes of IRS, including 14 caused by mycobacterial organisms, 7 by varicella-zoster virus, 7 by herpes simplex virus, 3 by Cryptococcus neoformans and 1 episode of Guillain-Barré syndrome. Patients who had IRS develop had lower baseline CD4 lymphocyte percentages compared with those who did not (P = 0.02).
  
  
  CONCLUSIONS
  IRS is common among HIV-infected children who received HAART in their advanced stage of disease. Educational programs for patients and health care workers on recognizing and treating these conditions should be integrated into antiretroviral treatment access programs.
authors.affiliation: Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthanakit
authors.forename: Peninnah
authors.initials: P
authors.lastname: Oberdorfer
authors.forename: Noppadon
authors.initials: N
authors.lastname: Akarathum
authors.forename: Pornphun
authors.initials: P
authors.lastname: Wannarit
authors.forename: Thira
authors.initials: T
authors.lastname: Sirisanthana
authors.forename: Virat
authors.initials: V
authors.lastname: Sirisanthana
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology*; D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003453:Cryptococcosis / Q000276:immunology; D005260:Female; D020275:Guillain-Barre Syndrome / Q000276:immunology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D006561:Herpes Simplex / Q000276:immunology; D006562:Herpes Zoster / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D009164:Mycobacterium Infections / Q000276:immunology; D013785:Thailand; D013997:Time Factors