Morning Report 11.1.10 g p

Key Points
• Immune reconstitution inflammatory syndrome presents as a paradoxical
deterioration in the clinical status of a patient with HIV infection after
iinitiation iti ti of f highly hi hl active ti antiretroviral ti t i l th therapy. MMost t cases of f IRIS ddevelop l
within a few weeks to a few months of commencement of HAART.
• IRIS can present in two different situations:
– an exacerbation of a partially or successfully treated opportunistic
infection
– a previously undiagnosed or subclinical infection.
• The signs and symptoms of tuberculous IRIS may include high fevers, new
or worsening lymphadenopathy, worsening of pulmonary symptoms, and a
new or increasing pleural effusion. Principles of management include
consideration of temporary HAART cessation in patients in whom
potentially ll life-threatening l f h f forms of f IRIS S develop, d l such h as in those h with h
severe neurologic disease. Most patients with IRIS are managed with
antimicrobial therapy to reduce the antigen load of the triggering
pathogen, short-term therapy with NSAIDs or corticosteroids to decrease
inflammation inflammation, and HAART continuation
continuation.