Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in children.

Journal Article (Journal Article)

BACKGROUND: Paradoxical tuberculosis (TB)-associated Immune Reconstitution Inflammatory Syndrome (IRIS) is a common complication of combination antiretroviral treatment (cART) initiation in adults residing in resource-limited regions. Little is known about the burden and presentation of TB-IRIS in children initiating cART while receiving TB treatment. METHODS: Prospective cohort study of South African children initiating cART while on TB treatment. Children were assessed clinically and by chest x-ray before starting cART and at 2, 4, 6, and 12 weeks post cART initiation. All children who presented with any signs or symptoms suggestive of paradoxical TB-IRIS were classified according to the consensus adult TB-IRIS case definition developed by the International Network for Study of HIV-associated IRIS (INSHI) and reviewed by an independent expert panel. RESULTS: In 7 of the 104 children enrolled in the cohort, symptoms and/or clinical or radiological signs suggestive of paradoxical TB-IRIS developed after a median of 14 days of cART. In two of these cases, there was agreement between the INSHI case definition and the expert panel. In an additional 3 cases, the INSHI criteria were fulfilled but the expert panel made an alternative diagnosis of pneumonia (n = 2) and poor adherence to cART (n = 1). CONCLUSIONS: The burden of paradoxical TB-IRIS in children with underlying TB initiating cART is low. Including response to antibiotic treatment for pneumonia as a criterion for an alternative diagnosis may improve the specificity of the INSHI case definition.

Full Text

Duke Authors

Cited Authors

  • Van Rie, A; Sawry, S; Link-Gelles, R; Madhi, S; Fairlie, L; Verwey, C; Mahomed, N; Murdoch, D; Moultrie, H

Published Date

  • February 2016

Published In

Volume / Issue

  • 51 / 2

Start / End Page

  • 157 - 164

PubMed ID

  • 26073306

Pubmed Central ID

  • PMC4678030

Electronic International Standard Serial Number (EISSN)

  • 1099-0496

Digital Object Identifier (DOI)

  • 10.1002/ppul.23221


  • eng

Conference Location

  • United States