IRIS — SCE Infectious Diseases MCQ

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ModerateHIV MedicineIRISSCE Infectious Diseases

A 35-year-old man with newly diagnosed HIV presents with extensive molluscum contagiosum lesions and a CD4 count of 85 cells/µL. Despite 6 months of effective ART (VL <50, CD4 risen to 280), the lesions have worsened and become inflamed. What is the most likely explanation?

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Correct answer: A — Immune reconstitution inflammatory syndrome (IRIS) directed against molluscum contagiosum

Molluscum-related IRIS is a paradoxical worsening of pre-existing molluscum contagiosum lesions following ART-induced immune reconstitution. The inflammatory response causes the lesions to become erythematous, swollen, and more prominent despite effective viral suppression and rising CD4 count. This is a benign and self-limiting form of IRIS. Management is conservative (the inflammation usually resolves over weeks) and ART should be continued. Physical treatments (cryotherapy, curettage) can be used for persistent lesions.

Reference: BHIVA 2022 – IRIS guidelines; NICE CKS 2024 – Molluscum