Introduction: People with HIV initiating combination antiretroviral therapy (cART) are at risk for tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS). While this syndrome has been well researched in adults, little is known about the incidence, case fatality, underlying immunopathology, and treatment approaches in children.
Methods: Major databases were searched for articles related to TB-IRIS in children. Data was abstracted using standardized forms.
Results: Thirteen studies were identified: six retrospective and two prospective cohort studies, one cross-sectional study, three case reports, and one case series. In total, 303 cases of TB-IRIS were described, of which 270 were unmasking TB-IRIS, 12 paradoxical TB-IRIS, and 21 were not classifiable due to lack of key information. None of the cohort studies had investigation of TB-IRIS as its primary aim. Nine studies were from Africa, three from Asia and one from Latin America. Age at cART initiation (reported by 12 studies) ranged from 1 month to 16 years. Median time from start cART to IRIS diagnosis (reported by 8 studies) ranged from 8 days to 16 weeks. Few deaths attributable to TB-IRIS were recorded. Treatment was only discussed in two case studies, both of which reported children receiving corticosteroids. No studies evaluated risk factors for, or immunopathogenesis of, pediatric TB-IRIS.
Conclusion: There is a paucity of information available on TB-IRIS in children. Future research assessing incidence, risk factors, case fatality, and optimal treatment or prevention strategies of TB-IRIS is needed.
(C) 2014 by Lippincott Williams & Wilkins, Inc.