Immune reconstitution inflammatory syndrome (IRIS)

Clinical description

• A small number of patients may get worse in the first 6 months after starting ART.
• The most common causes for this are (in the order of likelihood):

o Undiagnosed / untreated OI, mainly TB o Poor adherence to ART o Drug-resistant TB (if on TB treatment)

o IRIS

• IRIS is an over-aggressive response of the immune system caused by a sudden recovery on ART.
• IRIS appears as a severe bout / worsening of an OI:

o TB o Cryptococcal meningitis o Herpes zoster o KS o Hepatitis

• IRIS should only be considered if the other causes for worsening have been ruled out.
• Patients who start ART with very advanced AIDS are at a higher risk of developing IRIS.