1. 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)

2. 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 ( )
0.02

3. 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.