Immune reconstitution inflammatory syndrome (IRIS) is an immune system response that activates a previously dormant infection. It’s most common in people who are receiving HIV treatment. It typically occurs within the first 6 months of treatment.
Most cases of IRIS are mild and resolve quickly. Without treatment, severe cases can be fatal. IRIS is treated by continuing antiretroviral therapy and treating the infection. In very severe cases, steroids may be needed as well.
IRIS occurs when ART medication reactivates the immune system as it begins to recover. While you do want your immune system to recover, the improved activity of the immune system can cause an overactive inflammatory response. These responses are usually to a pathogen that’s present in the body but wasn’t causing any symptoms before ART treatment — but it could also develop from a new infection.
Pathogens associated with IRIS include:
- tuberculosis (TB)
- herpes virus family, including herpes simplex virus, herpes zoster virus, and HHV 8
- hepatitis B
- cytomegalovirus (CMV)
- progressive multifocal leukoencephalopathy
- Mycobacterium avium complex
- Pneumocystis jirovecii pneumonia
- atypical mycobacterium
IRIS often resolves quickly. However, IRIS that activates a serious underlying infection can be fatal without treatment.
If you’re taking an ART medication, make sure to keep your doctor well informed of any new or recurring symptoms that develop.
IRIS is an immune system response to ART. It’s
This weakened immune system state allows infections to sit dormant in the body. In some cases, infections were treated previously and symptoms were resolved. In other cases, the infection never caused any symptoms and was never diagnosed.
When people begin taking ART medication, it strengthens the immune system. This can cause the immune system to over-respond to these dormant infections. In turn, this leads to inflammation and symptoms of the infection.
IRIS most often occurs within the first
Make sure to talk with your doctor before joining any clinical trial, especially if it involves any change to your treatment regimen.
The symptoms of IRIS in people with HIV depend on the underlying infection.
Symptoms can be mild or severe. Some people who develop IRIS have no symptoms at all.
The biggest sign of IRIS is an overactive inflammatory response. Symptoms of common underlying infections are discussed below.
Symptoms in people with underlying TB can include:
- night sweats
- unintentional weight loss
- shortness of breath
- difficulty breathing
- skin lesions
- swollen lymph nodes that might be sore or tender to the touch
Symptoms in people with underlying pneumonia can include:
Symptoms in people with underlying hepatitis can include:
Mild cases of IRIS can sometimes resolve on their own because ART helps boost the immune system.
In most cases, the standard treatment for the underlying infection is also effective in curing IRIS.
Medication for the underlying infection could be an:
People with moderate to severe IRIS who are experiencing painful or disruptive symptoms might also receive treatments for those symptoms. This can include:
Most cases of IRIS are mild and resolve quickly without lasting effects. Severe cases can cause serious symptoms and can be fatal.
Infections that affect the brain or nervous system, such as meningitis, are considered especially dangerous.
Although IRIS is an unwanted side effect of ART, people with IRIS continue to take ART in almost all cases. ART allows the immune system to recover from any damage HIV has caused. As the immune system gets stronger, it can fight the underlying infection that’s causing IRIS.
Living with HIV
HIV can be a stressful disease to live with. It’s important to have support as you manage your condition. Consider turning to these great resources for support and guidance:
- The Well Project: The Well Project offers supportive resources and forums where women and girls with HIV can connect and find support.
- POZ Community Forums: POZ Community Forums are discussion boards for people with HIV to share stories, tips, support, and more.
- Positive Peers: You can use your smartphone app to access Positive Peers, a supportive group for people between ages 13 and 34 who have HIV.
- Thrive SS: Black gay or bisexual men can connect with Thrive SS to find local peer support groups and mental health resources.
- Housing Opportunities for Persons With AIDS (HOPWA): People with HIV and their families can secure housing through the federal Housing Opportunities for Persons With AIDS (HOPWA) program.
- Ryan White HIV/AIDS Program: People who meet income requirements can get financial assistance through the Ryan White HIV/AIDs program.
IRIS is an immune system response that can occur during the first few months of ART treatment for HIV.
IRIS reactivates an old infection and leads to new symptoms. The symptoms of IRIS depend on the underlying infection.
Not all cases of IRIS cause symptoms. When symptoms are present, they can be mild, moderate, or severe.
In many cases, IRIS is mild and resolves quickly without any complications. Severe cases can be fatal if left untreated. Make sure to talk with your doctor if any new symptoms develop during your HIV treatment.