title: The clinical pattern, prevalence, and factors associated with immune reconstitution inflammatory syndrome in Ugandan children.
abstract: OBJECTIVE
  To determine clinical pattern, prevalence, and factors associated with pediatric immune reconstitution inflammatory syndrome (IRIS) in Uganda.
  
  
  METHODS
  A prospective, multicenter cross-sectional study.
  
  
  METHODS
  We enrolled HIV-infected children receiving antiretroviral therapy (ART) between 0.5 and 6 months duration from December 2006 to October 2007 at three pediatric clinics in Uganda. Children were evaluated for IRIS at a one-time study visit by a standardized pediatric case definition.
  
  
  RESULTS
  The IRIS prevalence was 38% [95% confidence interval (CI) 31-46] among 162 children (57% female) with a median age of 6 years (interquartile range 2.5-11 years). Of the IRIS events, 77% were unmasking of a new opportunistic infection and 23% were probable paradoxical IRIS events toward prior opportunistic infections. The majority of IRIS events (55%) occurred in the first month of ART. The clinical events were diverse, with tuberculosis-IRIS (29%) being the most frequent presentation. Independent risk factors for IRIS were pre-ART CD4(+) cell percentage below 15% (odds ratio = 3.1, 95% CI 1.2-8.4, P = 0.027), current CD8(+) cell absolute count below 1000 cells/microl (odds ratio = 4.3, 95% CI 1.8-10.4, P = 0.001), male sex (odds ratio = 2.6, 95% CI 1.06-8.4, P = 0.01), and a cough of more than 1 week duration at the current clinic visit (odds ratio = 4.3, 95% CI 1.7-10.7, P = 0.002). A more than 25 CD4(+) T-cells increase at current study visit from the pre-ART baseline was associated with IRIS by univariate (P = 0.005) but not multivariate analysis.
  
  
  CONCLUSIONS
  IRIS events commonly occur early after ART initiation in children with advanced immunosuppression, as commonly seen in resource-limited areas. Both healthcare providers and caregivers of the children need awareness of IRIS to minimize ART nonadherence.
authors.affiliation: Department of Pediatrics and Child Health, Makerere University College of Health Sciences and Mulago National Referral Hospital, Uganda. jtatorichdr@yahoo.com
authors.forename: Judy
authors.initials: J
authors.lastname: Orikiiriza
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bakeera-Kitaka
authors.forename: Victor
authors.initials: V
authors.lastname: Musiime
authors.forename: Edison A
authors.initials: EA
authors.lastname: Mworozi
authors.forename: Peter
authors.initials: P
authors.lastname: Mugyenyi
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014454:Uganda / Q000453:epidemiology; D016903:Drug Monitoring