Immune reconstitution syndrome after highly active antiretroviral therapy in human immunodeficiency virus-infected Thai children

Background: There is little information about the immune reconstitution syndrome (IRS) in children, especially from resource-poor countries. Objective: To determine the incidence and spectrum of IRS in advanced stage human immunodeficiency vir-us (HIV)-infected children after initiation of highly active antiretroviral therapy (HAART). Methods: Between May 2002 and April 2004, 153 symptomatic HIV-infected children who had CD4 lymphocyte percentage <= 15% initiated HAART in a national antiretroviral drug access program. All patients were followed for 48 weeks. In this study, IRS was defined as a disease event caused by microorganisms or conditions previously reported to be associated with IRS in patients having immunologic and/or virologic response to HAART. Results: The incidence of IRS was 19% (95% confidence interval, 13.1 - 26.1). The median time of onset was 4 weeks after start of HAART (range, 2 - 31). There were 32 episodes of IRS, including 14 caused by mycobacterial organisms, 7 by varicella-zoster virus, 7 by herpes simplex virus, 3 by Cryptococcus neoformans and I episode of Guillain-Barre syndrome. Patients who had IRS develop had lower baseline CD4 lymphocyte percentages compared with those who did not (P = 0.02). Conclusions: IRS is common among HIV-infected children who received HAART in their advanced stage of disease. Educational programs for patients and health care workers on recognizing and treating these conditions should be integrated into antiretroviral treatment access programs.