Case 33. IRIS – Bumps Along the Road to Recovery
Download MP3A 30-year-old bisexual man is hospitalized and diagnosed with advanced HIV disease and presumptive Pneumocystis pneumonia (PCP). He has an initial CD4 cell count of 34 cells/cubic-mm and viral load of 160,000 copies/mL, and he is treated with bictegravir/emtricitabine/tenofovir alafenamide, broad-spectrum antibiotics, and trimethoprim sulfamethoxazole. After discharge, the patient reports headaches and fever. Listen as Chris Hoffmann and Eileen Scully from Johns Hopkins discuss the patient’s laboratory results, the differential for these symptoms, the biology of immune reconstitution inflammatory syndrome (IRIS), and symptom management.
References:
References:
- Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med 2014 Jun 26;370(26):2487-98. PMID: 24963568
- Török ME, Yen NT, Chau TT, et al. Timing of initiation of antiretroviral therapy in human immunodeficiency virus (HIV)--associated tuberculous meningitis. Clin Infect Dis 2011 Jun;52(11):1374-83. PMID:21596680
Related Guidelines:
- NYSDOH AI: Management of IRIS
- DHHS:
Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV
