HIV-IRIS (Immune Reconstitution Inflammatory Syndrome) (Ref: Cecil Text Book)
- Paradoxical IRIS:
- worsening or atypical features or both of established OI; Usually OI is treated before ART, and inflammation is against residual antigen;
- It often depends on the timing of ART initiation
- Unmasking IRIS: Disease occurs for the first time after ART initiation (most likely patient has subclinical established infection)
- Examples
- IRIS is most common with MAC, TB and fungal infection including cryptococcal.
- Mycobacterial Infection (Tubercular, NTM, Leprea, BCG, MAC)
- Viral (CMV, HHV-8 or KS-IRIS, HBV, HCV, Herpes-Zoster, JC Virus, Mulluscum Contagiosum)
- Fungal
- Cryptococcal
- CNS IRIS: intracranial cryptococcoma or abscesses, spinal cord abscesses, recalcitrant raised intracranial pressure, optic disc swelling, cranial nerve lesions, dysarthria, hemiparesis, and paraparesis.
- Extra-CNS IRIS: lymphadenitis, eye disease, suppurating soft tissue lesions, and pulmonary disease that may include cavitating or nodular lesions.
- Pneumocystis
- Inflammatory: Inflammatory Seborrheic Dermatitis (Pityrosporon sp )
- Pathogenesis:
- Mycobacterial: Related to TH1 cellular immune response - IFN Y
- Other organism: Not fully clear
- Inflammatory PML: Increased CD8+ cells infiltration
- References
Dissemenated MAC (IRIS) :Fever, Chills, Sweats, Fatigue, Weight Loss - Sx: Abdominal pain, N, V
- Signs: Diffuse Lymhadenopathy, Hepatomegaly, Splenomegaly,
- Imaging: Retroperitoneal Lymphadenopathy
- Rx: Macrolide based Multidrug regiment, usually clarithromycin and ethambutal
CMV IRIS (Retinitis, Hepatitis, Colitis, Esophagitis) - Sx: Visual Sx
- Signs: Cytopenias, Hepatits, Retinitis
Candida: Usually does not cause disseminated cardidal infection in AIDS, but rather a mucocutaneous infection - Hence, neither disseminated infection nor systemic symptoms of candida occur in HIV
Cryptococcal IRIS - CNS IRIS: intracranial cryptococcoma or abscesses, spinal cord abscesses, recalcitrant raised intracranial pressure, optic disc swelling, cranial nerve lesions, dysarthria, hemiparesis, and paraparesis.
- Extra-CNS IRIS: lymphadenitis, eye disease, suppurating soft tissue lesions, and pulmonary disease that may include cavitating or nodular lesions.
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