An HIV-positive patient with CD4 count 45 cells/μL is started on ART. Two weeks later he develops worsening cervical lymphadenopathy and fever. Prior to ART, a positive tuberculin skin test was noted but IGRA was not done. What phenomenon best explains this deterioration?

• A Immune reconstitution inflammatory syndrome (IRIS) ✓
• B Drug-induced lupus from ART
• C Primary ART resistance
• D Kaposi sarcoma flare

Explanation

Immune reconstitution inflammatory syndrome (IRIS) occurs when recovering immunity mounts an exaggerated response against pre-existing subclinical infections; paradoxical IRIS worsens known infections (here likely TB) after ART initiation. Drug-induced lupus and primary resistance do not produce lymphadenopathy flares within two weeks. Kaposi sarcoma is not triggered by immune recovery in this pattern.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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