Immune Reconstitution Inflammatory Syndrome [IRIS]

Paradoxical Reaction

Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs, or radiographic manifestation of TB after beginning TB treatment due to simultaneous administration of Anti-retroviral Treatment (ART) and TB medication. It was thought to be a result of immune reconstitution and is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS).

Symptoms and Signs

• High fever
• Lymphadenopathy
• Expanding intrathoracic lesions
• Worsening of chest radiographic findings 

Diagnosis: Made only after a thorough evaluation has excluded other etiologies, particularly where TB treatment has failed

Treatment: For severe paradoxical reactions, prednisolone (1–2 mg/kg for 1–2 weeks, then gradually decreasing dose) may be used.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• WHO Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.
• Technical and Operational Guidelines for TB in India, 2016.
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.

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