Immune reconstitution inflammatory syndrome in children.

Paradoxical deterioration due to immune reconstitution inflammatory syndrome (IRIS) occurs in up to 21% of children initiating antiretroviral therapy. Mycobacterial diseases are the most common, with BCG-vaccine adenitis predominating in infants and Mycobacterium tuberculosis (TB) in older children. The difficulty of diagnosing TB in HIV-infected children and the increasing risk of drug-resistant TB complicate the diagnosis and management of both paradoxical IRIS and post-antiretroviral therapy TB. History and clinical assessment remain key strategies in the management of these infants and children. There are no prospective studies investigating diagnostic criteria and therapeutic strategies in children.