Tuberculosis Immune Reconstitution Inflammatory Syndrome in children initiating Antiretroviral Therapy for HIV infection: A systematic literature review.
Tuberculosis Immune Reconstitution Inflammatory Syndrome in children initiating Antiretroviral Therapy for HIV infection: A systematic literature review.
复制标题
开始针对艾滋病毒感染进行抗逆转录病毒治疗的儿童中的结核病免疫重建炎症综合征：系统文献综述。
DOI：
10.1097/inf.0000000000000142
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
VanRie,Annelies
中科院分区：
文献类型：
--
作者：
Link-Gelles,Ruth;Moultrie,Harry;Sawry,Shobna;Murdoch,David;VanRie,Annelies
背景：开始联合抗逆转录病毒治疗的HIV患者有患结核病相关免疫重建炎症综合征(TB-IRIS)的风险。虽然这种综合征在成人中已经得到了很好的研究，但对儿童的发病率、病死率、潜在的免疫病理学和治疗方法知之甚少。方法：检索主要数据库中与儿童TB-IRIS相关的文章。结果：确定了13项研究：6项回顾研究和2项前瞻性队列研究，1项横断面研究，3项病例报告和1项病例系列研究。总共描述了303例TB-IRIS，其中270例是显性的TB-IRIS，12例是矛盾的TB-IRIS，21例由于缺乏关键信息而无法分类。没有一项队列研究以调查结核病-IRIS为主要目的。9项研究来自非洲，3项来自亚洲，1项来自拉丁美洲。启动CART的年龄(12项研究报告)从1个月到16岁不等。从CART开始到IRIS诊断的中位时间(由8项研究报告)从8天到16周不等。记录的可归因于结核病-IRIS的死亡人数很少。治疗只在两个案例研究中讨论，这两个案例都报告了儿童接受皮质类固醇治疗。没有研究评估儿童TB-IRIS的危险因素或免疫发病机制。结论：关于儿童TB-IRIS的可用信息很少。未来需要进行研究，评估结核病-IRIS的发病率、风险因素、病死率和最佳治疗或预防策略。
Background:People with HIV initiating combination antiretroviral therapy 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 were abstracted using standardized forms.Results:Thirteen studies were identified: 6 retrospective and 2 prospective cohort studies, 1 cross-sectional study, 3 case reports and 1 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, 3 from Asia and 1 from Latin America. Age at cART initiation (reported by 12 studies) ranged from 1 month to 16 years. Median time from start of 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 2 case studies, both of which reported children receiving corticosteroids. No studies evaluated risk factors for, or immunopathogenesis of, pediatric TB-IRIS.Conclusions: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.