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Pediatric Radiology

, 39:569 | Cite as

Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children

  • Tracy Kilborn
  • Marco Zampoli
Minisymposium

Abstract

The outcome of HIV infection has improved since the widespread availability of highly active antiretroviral therapy (HAART). Some patients, however, develop a clinical and radiological deterioration following initiation of HAART due to either the unmasking of occult subclinical infection or an enhanced inflammatory response to a treated infection. This phenomenon is believed to result from the restored ability to mount an immune response and is termed immune reconstitution inflammatory syndrome (IRIS) or immune reconstitution disease. IRIS is widely reported in the literature in adult patients, most commonly associated with mycobacterial infections. There is, however, a paucity of data documenting the radiological findings of IRIS in children. Radiologists need to be aware of this entity. As a diagnosis of exclusion it is essential that the radiological findings be assessed in the context of the clinical presentation. This article reviews the common clinical and radiological manifestations of IRIS in HIV-infected children.

Keywords

HIV Highly active antiretroviral therapy Immune reconstitution inflammatory disease Tuberculosis Children 

References

  1. 1.
    Emery S, Lane C (1997) Immune reconstitution in HIV infection. Curr Opin Immunol 9:568–572PubMedCrossRefGoogle Scholar
  2. 2.
    Hirsch H, Kaufmann G, Sendi P et al (2004) Immune reconstitution in HIV infected patients. Clin Infect Dis 38:1159–1166PubMedCrossRefGoogle Scholar
  3. 3.
    Robertson J, Meier M, Wall J et al (2006) Immune reconstitution syndrome in HIV: validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis 42:1639–1646PubMedCrossRefGoogle Scholar
  4. 4.
    Lawn S, Bekker LG, Miller RF (2005) Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis 5:361–373PubMedCrossRefGoogle Scholar
  5. 5.
    Shelburne SA 3rd, Hamill RJ (2003) The immune reconstitution inflammatory syndrome. AIDS Rev 5:67–79PubMedGoogle Scholar
  6. 6.
    Boulware D, Callens S, Pahwa S (2008) Pediatric HIV immune reconstitution inflammatory syndrome. Curr Opin HIV AIDS 3:461–467PubMedCrossRefGoogle Scholar
  7. 7.
    Cheng VC, Yuen KY, Wong SS et al (2001) Immunorestitution diseases in patients not infected with HIV. Eur J Clin Microbiol Infect Dis 20:402–406PubMedCrossRefGoogle Scholar
  8. 8.
    Zampoli M, Kilborn T, Eley B (2007) Tuberculosis during early antiretroviral-induced immune reconstitution in HIV-infected children. Int J Tuberc Lung Dis 11:417–423PubMedGoogle Scholar
  9. 9.
    Nuttal J, Wilmshurst J, Ndondo A et al (2004) Progressive multifocal leukoencephalopathy after initiation of highly active antiretroviral therapy in a child with advanced human immunodeficiency syndrome: a case of immune reconstitution inflammatory syndrome. Pediatr Infect Dis J 23:683–685CrossRefGoogle Scholar
  10. 10.
    Puthanakit T, Oberdorfer P, Akarathum N et al (2006) Immune reconstitution after highly active antiretroviral therapy in human immunodeficiency virus-infected Thai children. Pediatr Infect Dis J 25:53–58PubMedCrossRefGoogle Scholar
  11. 11.
    Walters E, Cotton M, Rabie H et al (2008) Clinical presentation and outcome of tuberculosis in human immunodeficiency virus infected children on anti-retroviral therapy. BMC Pediatr 8:1PubMedCrossRefGoogle Scholar
  12. 12.
    Lawn S, Myer L, Bekker LG et al (2007) Tuberculosis-associated immune reconstitution disease: incidence, risk factors and impact in an antiretroviral treatment service in South Africa. AIDS 21:335–341PubMedCrossRefGoogle Scholar
  13. 13.
    DeSimone JA, Pomerantz R, Babinchak T (2000) Inflammatory reactions in HIV-1 affected persons after initiation of highly active anti-retroviral therapy. Ann Intern Med 133:447–454PubMedGoogle Scholar
  14. 14.
    French MA, Price P, Stone S (2004) Immune restoration disease after antiretroviral therapy. AIDS 18:1615–1627PubMedCrossRefGoogle Scholar
  15. 15.
    Ch’ng TW, Dieudonne A (2007) Immune reconstitution inflammatory syndrome associated with progressive multifocal leukoencephalopathy in a perinatally acquired human immunodeficiency virus-infected young adult. Pediatr Infect Dis J 26:1068–1069PubMedCrossRefGoogle Scholar
  16. 16.
    Hesseling AC, Rabie H, Marais BJ et al (2006) Bacille Calmette-Guérin vaccine-induced disease in HIV-infected and HIV-uninfected children. Clin Infect Dis 42:548–558PubMedCrossRefGoogle Scholar
  17. 17.
    Corbett EL, Watt CJ, Walker N et al (2003) The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 163:1009–1021PubMedCrossRefGoogle Scholar
  18. 18.
    Rajeswaran G, Becker JL, Michailidis C et al (2006) The radiology of IRIS (immune reconstitution inflammatory syndrome) in patients with mycobacterial tuberculosis and HIV co-infection: appearances in 11 patients. Clin Radiol 61:833–843PubMedCrossRefGoogle Scholar
  19. 19.
    Buckingham S, Haddow LJ, Shaw PJ et al (2004) Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting active anti-retroviral therapy. Clin Radiol 59:505–513PubMedCrossRefGoogle Scholar
  20. 20.
    van der Weert EM, Hartgers NM, Schaaf HS et al (2006) Comparison of diagnostic criteria of tuberculous meningitis in human immunodeficiency virus-infected and uninfected children. Pediatr Infect Dis J 25:65–69PubMedCrossRefGoogle Scholar
  21. 21.
    Miralles P, Berenguer J, García de Viedma D et al (1998) Treatment of AIDS-associated progressive multifocal leukoencephalopathy with highly active antiretroviral therapy. AIDS 12:2467–2472PubMedCrossRefGoogle Scholar
  22. 22.
    Morriss MC, Rutstein RM, Rudy B et al (1997) Progressive multifocal leukoencephalopathy in an HIV-infected child. Neuroradiology 39:142–144PubMedCrossRefGoogle Scholar
  23. 23.
    Berger JR, Scott G, Albrecht J et al (1992) Progressive multifocal leukoencephalopathy in HIV-1 infected children. AIDS 6:837–841PubMedCrossRefGoogle Scholar
  24. 24.
    Collazos J, Mayo J, Martinez E et al (1999) Contrast enhancing progressive multifocal leukoencephalopathy as an immune reconstitution event in AIDS patients. AIDS 13:1426–1428PubMedCrossRefGoogle Scholar
  25. 25.
    Marais BJ, Pienaar J, Gie R (2003) Kaposi sarcoma with airway obstruction and bilateral chylothoraces. Pediatr Infect Dis J 22:926–928PubMedCrossRefGoogle Scholar
  26. 26.
    Theron S, Andronikou S, Du Plessis J et al (2007) Pulmonary Kaposi sarcoma in six children. Pediatr Radiol 37:1224–1229PubMedCrossRefGoogle Scholar
  27. 27.
    Goday MC, Rouse H, Brown JA et al (2007) Imaging of pulmonary Kaposi sarcoma-associated immune reconstitution syndrome. AJR 189:956–965CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Paediatric RadiologyRed Cross War Memorial Children’s HospitalCape TownSouth Africa
  2. 2.Department of Paediatric PulmonologyRed Cross War Memorial Children’s HospitalCape TownSouth Africa

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