IRIS: A concern for people
starting HIV therapy

April 2008     View PDF     En español

What is IRIS?

IRIS is a serious condition that can occur shortly after a person starts HIV therapy for the first time. It can also occur in people who restart their meds after a time being off them. IRIS happens when your immune system recovers too quickly. It can start to “overwork” and respond to other infections that may or may not have been diagnosed before starting therapy, even ones that may have already been under control.

When your immune system responds in this way it results in inflammation, and the inflammation that flares up can cause symptoms, sometimes severe. For some, these symptoms can be life-threatening. Though most cases of IRIS resolve after a few weeks, the symptoms may be mistaken by you or your doctor as HIV disease progression or another condition. IRIS is a paradoxical situation because, as your immune system responds to an infection, the inflammation that occurs actually makes your symptoms worse.

Most people who start their first regimens do not develop IRIS. And of those who do, many cases resolve on their own. However, it’s wise to report these symptoms to your health provider as soon as possible.

When IRIS does occur, it happens more often in people with TB and other mycobacterial infections, accounting for about 2 in 5 of the total IRIS cases. However, many other bacteria and viruses can contribute to IRIS. The box at right provides a list of the known infections. Some chronic conditions, particularly autoimmune disorders like rheumatoid arthritis, lupus or Grave’s disease, may become aggravated by IRIS.

• CMV, or cytomegalovirus
• Crytococcal meningitis, or Cryptococcus
• Eosinophilic folliculitis
• Hepatitis B and C
• Herpes, or HSV
• Herpes zoster, or Shingles, Varicella-zoster, VZV
• Human papillomavirus, or HPV
• Kaposi sarcoma and Castleman’s disease, or HHV8
• MAC, or Mycobacterium avium complex
• PCP, or Pneumocystis jiroveci pneumonia
• PML, or progressive multifocal leukoencephalopathy (caused by the JC virus)
• TB, or Mycobacterium tuberculosis