Immune Reconstitution Inflammatory Syndrome (IRIS)
Description Diagnostic criteria Medicine treatment ICD-10 code: D89.3 DESCRIPTION Clinical deterioration can occur after starting ART due an improvement in the immune system response to organisms already causing infection, e.g. M bovis BCG, C. neoformans, M. tuberculosis (MTB), Aspergillus, M. avium complex, C. albicans, M. leprae, Human Herpes viruses, P. jiroveci, Human Papilloma virus, CMV, He
Description
Diagnostic criteria
Medicine treatment
ICD-10 code: D89.3
DESCRIPTION
Clinical deterioration can occur after starting ART due an improvement in the immune system response to organisms already causing infection, e.g.
- M bovis BCG,
- C. neoformans,
- M. tuberculosis (MTB),
- Aspergillus,
- M. avium complex,
- C. albicans,
- M. leprae,
- Human Herpes viruses,
- P. jiroveci,
- Human Papilloma virus,
- CMV,
- Hepatitis B and C viruses (HBV, HCV),
- JC virus.
There are 2 manifestations of IRIS:
- Unmasking occurs when a previously unsuspected condition manifests.
- Paradoxical, i.e. known condition on appropriate treatment worsens.
DIAGNOSTIC CRITERIA
- Exclude other active or inadequately treated diseases (including MDR-TB).
- Ensure adherence to the prescribed therapy.
- Presentation:
- Usually during the first 6 weeks after starting ART.
- Clinical presentation depends on the causative organism and the organ-system involved, e.g. TB presents with fever, lymphadenopathy, worsening of the original tuberculous lesion, and/or deteriorating chest radiographic manifestations such as miliary pattern or pleural effusion.
MEDICINE TREATMENT
Treat underlying disease aggressively.
Antimicrobial therapy for specific infections.
In severe reactions:
- Prednisone, oral, 1.5 mg/kg daily for 2 weeks followed by 0.75 mg/kg daily for 2 weeks.
Usually ART is continued, and the underlying condition managed.
Local IRIS with M. bovis BCG usually does not require antimicrobial therapy.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 9: Human Immunodeficiency Virus Infections, 9.3 Immune Reconstitution Inflammatory Syndrome (IRIS)