Abstract
Immune Reconstitution Inflammatory Syndrome (IRIS) refers to a collection of inflammatory disorders, predominantly related to infectious processes that manifest after the initiation of antiretroviral therapy (ART) and can be classified as unmasking or paradoxical. The prevalence of IRIS in children in sub-Saharan Africa is low. Approximately half of all cases are associated with Mycobacterium tuberculosis. It may be difficult to distinguish IRIS from tuberculosis and other opportunistic infections radiologically; therefore, radiological findings must be interpreted with clinical and laboratory findings. In this review article, we describe the clinical and radiological manifestations of IRIS in children and provide illustrative radiological examples.
Highlights
Antiretroviral therapy (ART) has revolutionised the care of HIV-infected children
Immune Reconstitution Inflammatory Syndrome (IRIS) refers to a collection of inflammatory disorders, predominantly related to infectious processes that manifest after initiation of ART
It may be difficult to distinguish IRIS from TB and other opportunistic infections so radiological findings must be interpreted in combination with clinical and laboratory findings.[16,17,31]
Summary
Antiretroviral therapy (ART) has revolutionised the care of HIV-infected children. Compared to untreated children, life expectancy and quality of life are substantially better for children receiving ART.[1,2] like any medication, ART has side effects and potential adverse consequences; the Immune Reconstitution Inflammatory Syndrome (IRIS) is one such adverse consequence.[3,4,5]IRIS refers to a collection of inflammatory disorders, predominantly related to infectious processes that manifest after initiation of ART. Local or systemic inflammatory changes occur related to a previously diagnosed (paradoxical IRIS) or unrecognised (unmasking IRIS) infectious condition – IRIS has been reported for non-infectious conditions, including malignancies and autoimmune diseases. Clinical manifestations of IRIS are dependent on the implicated pathogen and frequently involve worsening of previously identified manifestations or the onset of new symptoms, similar to those encountered with non-IRIS– related infections with the same pathogen.
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