ART was initiated when indicated by WHO and national guidelines Immune reconstitution inflammatory syndrome in the first 6 months of antiretroviral therapy in HIV-infected Ugandan children. Presenter: Jane Achan Prospective observational study of 83 HIV infected children aged 1-10 years starting ART between October 2005 and November 2007 at Mulago Hospital in Uganda. Objectives were to: Characterize the frequency of IRIS in this population Describe the clinical spectrum of IRIS events in this population Determine the predictors of IRIS in this population ART was initiated when indicated by WHO and national guidelines Participants were evaluated for IRIS events during the first 6 months following ART initiation. Participants seen monthly for follow-up visits IRIS was defined as a clinical deterioration from an infectious or inflammatory condition temporally related to the initiation of ART. (Boulware et al, Current Opinion in HIV and AIDS 2008)

IRIS events seen in HIV infected children completing 6 months of therapy Patients Events Any 44 (53%) 109 Acute pulm. syndrome 35(76%) 68 (62%) Pustular rash 9(20%) 9 (8%) Oral herpes simplex 5(11%) 7 (6%) Acute parotitis 3(6.8%) 5 (5%) Septicaemia 5 (5%) Oral candidiasis 2(4.5%) 4 (4%) Herpes zoster 4(9%) Molluscum 2 (2%) Tonsillitis Varicella zoster Abdominal TB 1(2%) 1 (1%) Clinical outcomes 5 patients hospitalized (all with acute pulmonary syndrome) No deaths due to IRIS ART therapy was not interrupted due to IRIS Predictors of IRIS Variable IRR (95% CI) P-value Δ CD4 at 2 weeks >180 vs. <180 1.31 (1.04-1.660) 0.02

Conclusion IRIS was common in the first 6 months of ART Seen in more than half of the patients Acute pulmonary syndrome was the predominant IRIS event followed by dermatologic manifestations Higher CD4 count increase at 2 weeks post ART initiation was associated with a greater risk of IRIS. There was a surprisingly low rate of TB IRIS in this population.