infections
Antiretroviral Treatment of Human Immunodeficiency Virus (HIV) Infection
Immune reconstitution inflammatory syndrome
The immune reconstitution inflammatory syndrome (IRIS) sometimes occurs when cART is successful. In IRIS, symptoms of various infections worsen or appear for the first time because immune responses improve (are reconstituted), increasing Inflammation at sites of infection. Symptoms sometimes worsen because parts of dead viruses persist, triggering immune responses. There are two forms of this syndrome: Paradoxical IRIS, which refers to the worsening of symptoms of an infection that doctors have already diagnosed Unmasked IRIS, which refers to the first appearance of symptoms of an infection that doctors had not previously diagnosed Paradoxical IRIS typically occurs during the first few months of treatment and usually resolves on its own. If it does not, corticosteroids, given for a short time, are often effective. Paradoxical IRIS is more likely to be severe when cART is started soon after treatment of an opportunistic infection is started. Thus, for some (but not all) opportunistic infections, cART is delayed until treatment of the opportunistic infection has reduced or eliminated the infection. In people with unmasked IRIS, doctors treat the newly identified opportunistic infection with antimicrobial medications. Occasionally, when the symptoms are severe, corticosteroids are also used. Usually, when unmasked IRIS occurs, cART is continued. An exception is when a Cryptococcosis affects the brain. Then cART is temporarily interrupted until the infection is controlled. 