8.6.2
Management of TB-related IRIS
National TB Management Guidelines, 2018 Edition. Chapter 8, TB and HIV.
Clinical description
- Before starting ART, counsel TB patients about the possibility of a temporary worsening
of symptoms.
- If a patient develops IRIS while on anti-TB treatment and ART, seek the advice of a
senior ART provider or medical specialist.
- There is no need to stop or change TB or ARV treatment.
- Confirm that the patient is adhering their medication regimen as prescribed. Admit
severe cases to hospital.
- Treat with:
o Dexamethasone, 16 mg/day (divided into twice daily dosing) or o prednisolone, 1 mg/kg body weight (once daily) for 14-21 days.
o After 14-21 days, rapidly taper the steroids over a 10 to14-day period while monitoring for recurrence and/or worsening of symptoms.
- Consider TB treatment failure or MDR-TB if the patient worsens despite having
received one or more months of anti-TB treatment.
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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