Cotton MF, et al. - Among children (<72 months of age) selected from public antiretroviral programs, researchers determined the incidence, clinical characteristics and risk factors of pediatric immune reconstitution inflammatory syndrome (IRIS) in Sub-Saharan Africa and India, via this observational multi-centred prospective clinical study. A new or worsening inflammatory event following starting antiretroviral therapy (ART) was the main diagnostic criterion for IRIS. The development of 45 episodes of IRIS was reported in 38 (18.8%) of 198 children with a median age 1.15 years. BCG, tuberculosis and dermatological were identified as the principal causes of IRIS. High HIV viral load, recruitment at 1 site (Stellenbosch University) and CD4 depletion were documented as the most significant baseline links with IRIS, on multivariate logistic regression. Overall, a common occurrence of IRIS was reported in HIV-infected children starting ART. IRIS occasionally has severe morbidity. The incidence may be underestimated.