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ID Board Review/Human Immunodeficiency Virus (HIV) Infection/Complications of HIV/Opportunistic Infections (OIs)/Immune reconstitution inflammatory syndrome (IRIS)

< ID Board Review‎ | Human Immunodeficiency Virus (HIV) Infection‎ | Complications of HIV‎ | Opportunistic Infections (OIs)

Definition edit

  • Dramatic inflammatory response to OI as immune response improves with initiation of ART
  • Immune system reconstitution “unmasks” active infections: Most commonly Mycobacterium avium, TB, or fungal infections
  • CMV retinitis, and crytpococcal meningitis can occur too
  • Typically occurs weeks-months after starting ART, w HIV VL falling sharply and CD4 rising

Clinical Diagnosis edit

  • High level of IRIS suspicion based on timing
  • Must rule out other causes and other infections

Management edit

  • Continue treating OIs
  • Continue ART if possible
    • May need to hold for a few days if Sx get severe
  • Treat symptomatically
  • May resort to steroids if IRIS is extremely severe

Prevention edit

  • In Pts w TB + HIV, start on TB treatment for at least 2 weeks
    • Then start ART
  • In Pts w cryptococcal meningitis + HIV, Tx the Crypto until intracranial pressures normalize
    • DO NOT START TX SIMULTANEOUSLY
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