Immune reconstitution inflammatory syndrome (IRIS) in HIV patients initiating ART is most commonly associated with which opportunistic infection, often presenting as paradoxical worsening after starting ART?
- A Cryptococcal meningitis (unmasking or paradoxical IRIS) ✓
- B Pneumocystis jirovecii pneumonia (PCP)
- C Toxoplasma encephalitis
- D CMV retinitis
Explanation
Cryptococcal IRIS is one of the most severe and studied forms, occurring in up to 30% of patients with baseline cryptococcal antigenemia who start ART. It can manifest as paradoxical IRIS (worsening after ART in treated cryptococcosis) or unmasking IRIS (diagnosis of previously sub-clinical cryptococcosis). Mortality from cryptococcal IRIS is high (~15–30%). Guidelines recommend delaying ART for at least 4–6 weeks after starting antifungal treatment for cryptococcal meningitis to reduce IRIS risk. Prednisolone does NOT benefit cryptococcal IRIS (ACTG A5164, IDSA 2016).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.