Immune reconstitution syndrome after highly active antiretroviral therapy in human immunodeficiency virus-infected thai children.
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.
Puthanakit
Thanyawee
T
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Oberdorfer
Peninnah
P
Akarathum
Noppadon
N
Wannarit
Pornphun
P
Sirisanthana
Thira
T
Sirisanthana
Virat
V
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