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Pediatric HIV immune reconstitution inflammatory syndrome

Boulware, David Ra; Callens, Stevenb,c; Pahwa, Savitad

Current Opinion in HIV and AIDS: July 2008 - Volume 3 - Issue 4 - p 461–467
doi: 10.1097/COH.0b013e3282fe9693
Immune restoration disease: Edited by Robert Colebunders and Martyn French

Purpose of review Little is known regarding HIV immune reconstitution inflammatory syndrome in children. As the antiretroviral therapy roll out has gathered pace since 2004 in resource-limited settings, pediatric immune reconstitution inflammatory syndrome has emerged as a clinical challenge.

Recent findings The incidence of immune reconstitution inflammatory syndrome appears to be between 10 and 20%. The commonest causes are mostly mycobacterial, including tuberculosis, atypical mycobacteria and bacillus Calmette–Guérin related. In many pediatric cohorts, however, a marked early mortality within the first 90 days of antiretroviral therapy occurs. This mortality is poorly understood, and the contribution of immune reconstitution inflammatory syndrome to this mortality is unknown.

Summary Children after starting antiretroviral therapy may have paradoxical worsening of previously treated opportunistic infections. Due to the differences, however, in children's immunology with vertical HIV transmission, children are probably at greater risk of unmasking occult, subclinical infections during immune reconstitution.

aInfectious Diseases and International Medicine, Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota, Minneapolis, Minnesota, USA

bDepartment of Internal Medicine, Catholic University Leuven, Leuven

cDepartment of Medicine University of Antwerp, Antwerp, Belgium

dDepartments of Microbiology and Immunology and Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida, USA

Correspondence to David R. Boulware, MD, MPH, DTM&H, MMC 250, 420 Delaware St. SE, Minneapolis, MN 55455, USA Tel: +1 612 624 9996; fax: +1 612 625 4410; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.