Management of Immune Reconstitution Inflammatory Syndrome (IRIS) [Internet]

This guideline was developed by the New York State Department of Health (NYSDOH) AIDS Institute (AI) for primary care providers and other practitioners who manage immune reconstitution inflammatory syndrome (IRIS) in patients with HIV.Although ART dramatically reduces HIV-associated mortality and improves patient outcomes, initiation of or a change in ART introduces the potential for IRIS. This early complication is seen most often within the first 8 weeks of therapy in patients with advanced HIV disease. Mild IRIS resolves over time in most patients, and symptomatic treatment is often sufficient. Severe IRIS may threaten a patient’s functional status or cause permanent disability or death. But interrupting combination ART in a patient with IRIS may lead to acquisition of new opportunistic infections, recurrence of IRIS when therapy is later restarted, and possible HIV-drug resistance.This guideline, therefore, addresses management of IRIS to avoid ART interruption except in life-threatening cases.