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859 Dermatologic Immune Reconstitution Inflammatory Syndrome (IRIS) In Children Receiving Art from a Community Outreach Program in Kampala
  1. A Bagenda1,
  2. J Mbabazi2,
  3. M Nalubega-Mboowa3
  1. 1International Health Sciences University, Entebbe
  2. 2Department of Peadiatrics and Child Health, Mulago Hospital Kampala
  3. 3Health Policy and Management, International Health Sciences University, Kampala, Uganda

Abstract

Background Orikiriiza (2011) demonstrated that dermatological manifestations were the most common IRIS events in children receiving ART. We aimed to find the incidence of dermatological-IRIS in children receiving ART for at least 12 weeks.

Methodology Retrospective review of medical charts for children who received ART between January 2010–December 2011. Non-adherent and regimen switch children excluded.

Results Total of 110 charts; median age 5.9 years (IQR 9.1months-11.9years).70 females (63.6%). 85children (77.2%) baseline WHO stage III/IV. All children received septrin. Median time on ART was 24weeks (IQR 13.2–40.8). Baseline CD4+% was < 15% for 77(70%), > = 15% for 33children. Viral load >399,000 copies were 76 children (69.1%) and < = 399,000 for 34 children. PPE had the highest incidence (47cases) after ART initiation. 10cases of verrucae planae, 9 Kaposi Sarcoma, Herpes Zoster and Tinea corporis each, 8molluscum contagiosum, 4tinea capitis, 3HSV and 1varicella zoster. Median time to develop PPE was 3weeks (IQR 10.3–50. 1days). Increasing age associated with IRIS; highest between 5–12 years (age correlated with degree of immunosuppression).

Viral load after 3 months; < 1log10 decrease for 45 children (40.9%), > = 1log10 decrease for 65children. Children who had > = 25cells/ul change in CD4+% (83 children) carried almost 3-fold risk for dermatologic -IRIS compared to children with < 25cells increase (69 Vs 9 cases [O.R 2.9 CI 1.40–11.02, p value 0.004]. No significant increased risk for dermatologic-IRIS based on viral load change.

Conclusion Prevalence of unmasking dermatological-IRIS was high. PPE accounted for highest mucocutaneous IRIS manifestations. Caregivers should be counseled about possible worsening of PPE with ART initiation.

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