Immune Reconstitution Inflammatory Syndrome (IRIS)

 

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Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026

 

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Description

Diagnostic criteria

Referral

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D89.3 + (Y41.5 + B24)

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)
• M. tuberculosis (MTB)

There are 2 types of IRIS:

1. Unmasking: when a previously unsuspected condition becomes manifest.
2. Paradoxical: known condition on appropriate treatment becomes worse.

DIAGNOSTIC CRITERIA

• Exclude other active or inadequately treated diseases (including DR-TB).
• Presentation:
  • Usually during the first 6 weeks after starting ART.
  • 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.

REFERRAL

All patients.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024

Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_ 11.13 Side Effects and Complications of ART_11.13.1 Immune Reconstitution Inflammatory Syndrome (IRIS)