• Annelies Van Rie, Shobna Sawry, Ruth Link-Gelles, Shabir Madhi, Lee Fairlie, Charl Verwey, Nasreen Mahomed, David Murdoch, and Harry Moultrie.
• Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
• Pediatr. Pulmonol. 2016 Feb 1; 51 (2): 157-64.

BackgroundParadoxical 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.MethodsProspective 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.ResultsIn 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).ConclusionsThe 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.© 2015 Wiley Periodicals, Inc.

36 keywords...

hide…