title: Tuberculosis Immune Reconstitution Inflammatory Syndrome in children initiating Antiretroviral Therapy for HIV infection: A systematic literature review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Major databases were searched for articles related to TB-IRIS in children. Data were abstracted using standardized forms.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Ruth
authors.initials: R
authors.lastname: Link-Gelles
authors.forename: Harry
authors.initials: H
authors.lastname: Moultrie
authors.forename: Shobna
authors.initials: S
authors.lastname: Sawry
authors.forename: David
authors.initials: D
authors.lastname: Murdoch
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D000293:Adolescent; D000349:Africa; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001208:Asia; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology* / Q000473:pathology*; D015994:Incidence; D007223:Infant; D007843:Latin America; D009026:Mortality; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000473:pathology*
chemical_list: D044966:Anti-Retroviral Agents
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