Immune reconstitution inflammatory syndrome

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Background

  • Two main forms:
    • Unmasking: an underlying, previously undiagnosed infection becomes clinically apparent following immune reconstitution
    • Paradoxical: a diagnosed and treated infection worsens following immune reconstitution

Microbiology

Risk Factors

  • High viral load
  • Low CD4 count

Clinical Manifestations

  • Varies by underlying infection
  • Onset usually a month following starting antiretrovirals, but can be up to a year