Immune Reconstitution Inflammatory Syndrome (IRIS)

Etiology

  • Reconstitution of immune system w/initiation of Anti-retroviral therapy→ profound inflammatory reaction as body responds to pathogen(s)/diseases

Risk Factors

  • Low cd4
  • Untreated or sub-optimally treated HIV
  • Known or quiescent opportunistic infections (OIs)
  • Cancer (e.g. Kaposis) or autoimmune d/o

Symptoms

  • F
  • Transient worsening of known infection/disease or unmasking of quiescent/unknown condition
  • Specific sx based on the OI(s)/pathological condition and the anatomic site where focused
  • Most commonly assoc w/mycobact, fungal or viral infxns
  • E.g: if pulmonary TB—>worsening sob and hypoxia
  • If CNS crypto→ worsening meningitis/head ache
  • If cmv retinitis→ worsening vision
  • Sx range from mild to severe
  • Occurs within days to ~8 weeks of starting ARVs (typically w/in 3w)
  • Then sx resolve & patient improves.