ID Board Review/Human Immunodeficiency Virus (HIV) Infection/Complications of HIV/Opportunistic Infections (OIs)/Immune reconstitution inflammatory syndrome (IRIS)
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Definition[edit | edit source]
- 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 | edit source]
- High level of IRIS suspicion based on timing
- Must rule out other causes and other infections
Management[edit | edit source]
- 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 | edit source]
- In Pts w cryptococcal meningitis + HIV, Tx the Crypto until intracranial pressures normalize
- DO NOT START TX SIMULTANEOUSLY