Abstract
6.2% (104/1669) of all children without prior TB. During the first 100 days of ART, the risk of unmasking TB-IRIS increased 2.7 fold compared to pre-ART (95% CI = 2.1 to 3.5; P < .001) with probable immune protection thereafter (RR = 0.41; 95% CI = 0.30 to 0.54; P = .002) through a median ART follow up of 439 days (IQR = 332 to 503). Only two paradoxical IRIS reactions occurred in children previously on anti-TB therapy. In time-to-event analysis, children with CD4 counts <200 cells/ L had a 41% longer time to TB unmasking (P = 0.04), implying a longer time was needed for restoration of antigen specific immunity. Conclusion: Unmasking of TB during immune reconstitution with ART is common among Ugandan children. This TB may represent: undiagnosed active TB at time of ART, latent or occult TB reactivating with ART, or incident TB cases via nosocomial spread in the clinic. More research is needed to enrich scientific output in this area.
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