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Incidence of Immune
Reconstitution Inflammatory
Syndrome in HIV Infected
Children in Peru
M.E. Wang1, M.E. Castillo2, J.R. Zunt3
1Stanford
University School of Medicine, Stanford, USA
2Instituto Nacional de Salud del Niño,
Infectious Diseases Service, Lima, Peru,
3University of Washington, Departments of Neurology, Global Health and
Medicine (Infectious Diseases), Seattle, USA
Research supported by the
NIH/Fogarty International Clinical Research Scholars Program
Introduction
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IRIS: Clinical deterioration due to an infectious or
inflammatory response shortly after the start of HAART
therapy, with concurrent immune recovery
10-32% incidence in adults, 19% in children
Methods
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Retrospective
Population: All children starting HAART
at the Instituto Nacional de Salud del
Niño, Peru, 2002-06
IRIS Definition: Occurrence of a condition previously
associated with IRIS within a year of starting HAART, in
a patient with virologic or immunologic success
Results
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91 patients evaluated
19.8% (18/91) of patients developed IRIS
• 33% of cases (6/18) from Mycobacterium spp.
 M. tuberculosis – 5 cases
 BCG adenitis – 1 case
• 33% of cases (6/18) from varicella zoster virus
• 33% of cases (6/18) from herpes simplex labialis
All cases resolved, no IRIS related mortality
Median time to onset: 6.6 weeks (Range 2-34)
33% had a previous diagnosis with the IRIS infection
39% required hospitalization for IRIS
Results
No significant differences between the IRIS and nonIRIS groups with regards to age, sex, treatment
regimen, CDC disease stage, pre-HAART CD4 count
Significant differences:
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IRIS
Non-IRIS
P-value
Pre-HAART Viral load (log10)
5.52
5.17
0.02
Percent with malnutrition
78%
42%
0.00
Conclusions
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IRIS is a common occurrence in HIV-infected children
starting HAART in Peru
Incidence and range of causes was similar to those
found in other studies
Future studies should examine risk factors so patients
more susceptible can be identified and treated
promptly