Which complications can occur?
Patients who start ART are at risk of developing complications related to the recovery of their immune system. Complications relating to immunocompromise (especially if CD4 levels are < 200) and/or HIV infection itself may also be seen.
Define the immune reconstitution inflammatory syndrome (IRIS).
an inflammatory syndrome that can occur after initiation of ART and consists of either the appearance of a new condition or worsening of a preexisting condition
Describe the etiology.
believed to result from the restoration of the immune system and its response to antigenic stimulation. The stimulus may be:
Infectious, e.g., mycobacteria, HSV, CMV, Cryptococcus
Autoimmune, e.g., sarcoidosis, rheumatoid arthritis, SLE
Malignant, e.g., non-Hodgkin lymphoma
Describe the clinical presentation and diagnosis.
Diagnosis = clinical
Develops within 4–8 weeks of initiation of ART
Presentation varies depending on the underlying illness, however, patients often have clinical deterioration and localized tissue inflammation.
Describe the management.
Provide supportive care and continue treatment of the associated condition, e.g., with antibiotics, chemotherapy.
Do not interrupt ART except in severe, life-threatening IRIS.
Consider corticosteroids (e.g., prednisone) for severe IRIS depending on the underlying cause.
Describe the prevention.
Initiation of ART: Start within two weeks or as soon as clinically stable in patients being treated for opportunistic infections, except in tuberculous meningitis, cryptococcal disease, and CMV retinitis.
Corticosteroids should not be used to prevent the development of IRIS.
Immune reconstitution inflammatory syndrome (IRIS)
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