Skip to main content

Advertisement

SpringerLink
Log in

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

  • Minisymposium
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Emery S, Lane C (1997) Immune reconstitution in HIV infection. Curr Opin Immunol 9:568–572

    Article  PubMed  CAS  Google Scholar 

  2. Hirsch H, Kaufmann G, Sendi P et al (2004) Immune reconstitution in HIV infected patients. Clin Infect Dis 38:1159–1166

    Article  PubMed  Google Scholar 

  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 42:1639–1646

    Article  PubMed  Google Scholar 

  4. Lawn S, Bekker LG, Miller RF (2005) Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis 5:361–373

    Article  PubMed  Google Scholar 

  5. Shelburne SA 3rd, Hamill RJ (2003) The immune reconstitution inflammatory syndrome. AIDS Rev 5:67–79

    PubMed  Google Scholar 

  6. Boulware D, Callens S, Pahwa S (2008) Pediatric HIV immune reconstitution inflammatory syndrome. Curr Opin HIV AIDS 3:461–467

    Article  PubMed  Google Scholar 

  7. Cheng VC, Yuen KY, Wong SS et al (2001) Immunorestitution diseases in patients not infected with HIV. Eur J Clin Microbiol Infect Dis 20:402–406

    Article  PubMed  CAS  Google Scholar 

  8. Zampoli M, Kilborn T, Eley B (2007) Tuberculosis during early antiretroviral-induced immune reconstitution in HIV-infected children. Int J Tuberc Lung Dis 11:417–423

    PubMed  CAS  Google Scholar 

  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 23:683–685

    Article  Google Scholar 

  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 25:53–58

    Article  PubMed  Google Scholar 

  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 8:1

    Article  PubMed  Google Scholar 

  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 21:335–341

    Article  PubMed  Google Scholar 

  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 133:447–454

    PubMed  CAS  Google Scholar 

  14. French MA, Price P, Stone S (2004) Immune restoration disease after antiretroviral therapy. AIDS 18:1615–1627

    Article  PubMed  CAS  Google Scholar 

  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 26:1068–1069

    Article  PubMed  Google Scholar 

  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 42:548–558

    Article  PubMed  CAS  Google Scholar 

  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 163:1009–1021

    Article  PubMed  Google Scholar 

  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 61:833–843

    Article  PubMed  CAS  Google Scholar 

  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 59:505–513

    Article  PubMed  CAS  Google Scholar 

  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 25:65–69

    Article  PubMed  Google Scholar 

  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 12:2467–2472

    Article  PubMed  CAS  Google Scholar 

  22. Morriss MC, Rutstein RM, Rudy B et al (1997) Progressive multifocal leukoencephalopathy in an HIV-infected child. Neuroradiology 39:142–144

    Article  PubMed  CAS  Google Scholar 

  23. Berger JR, Scott G, Albrecht J et al (1992) Progressive multifocal leukoencephalopathy in HIV-1 infected children. AIDS 6:837–841

    Article  PubMed  CAS  Google Scholar 

  24. Collazos J, Mayo J, Martinez E et al (1999) Contrast enhancing progressive multifocal leukoencephalopathy as an immune reconstitution event in AIDS patients. AIDS 13:1426–1428

    Article  PubMed  CAS  Google Scholar 

  25. Marais BJ, Pienaar J, Gie R (2003) Kaposi sarcoma with airway obstruction and bilateral chylothoraces. Pediatr Infect Dis J 22:926–928

    Article  PubMed  Google Scholar 

  26. Theron S, Andronikou S, Du Plessis J et al (2007) Pulmonary Kaposi sarcoma in six children. Pediatr Radiol 37:1224–1229

    Article  PubMed  Google Scholar 

  27. Goday MC, Rouse H, Brown JA et al (2007) Imaging of pulmonary Kaposi sarcoma-associated immune reconstitution syndrome. AJR 189:956–965

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatric Radiology, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch 7925, Cape Town, South Africa

    Tracy Kilborn

  2. Department of Paediatric Pulmonology, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch 7925, Cape Town, South Africa

    Marco Zampoli

Authors
  1. Tracy Kilborn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Zampoli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tracy Kilborn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kilborn, T., Zampoli, M. Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children. Pediatr Radiol 39, 569–574 (2009). https://doi.org/10.1007/s00247-009-1192-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-009-1192-y

Keywords

Search

Navigation