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Dermatological IRIS — SCE Infectious Diseases MCQ

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ModerateHIV MedicineDermatological IRISSCE Infectious Diseases

A 35-year-old man with HIV (CD4 250, just started ART 2 weeks ago) develops a widespread papulopustular folliculitis and worsening of pre-existing seborrhoeic dermatitis. His VL has dropped from 150,000 to 8,000. What is the most likely explanation?

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Correct answer: B — Dermatological IRIS — immune reconstitution causing inflammatory skin flare

Skin-related IRIS is one of the most common forms of immune reconstitution inflammatory syndrome. As the immune system recovers following ART initiation, pre-existing conditions (folliculitis, seborrhoeic dermatitis, molluscum, warts, herpes) can paradoxically worsen through restored inflammatory responses. The dropping viral load confirms ART efficacy, excluding treatment failure. Management is symptomatic (topical treatments), ART continuation, and reassurance — the condition is typically self-limiting over weeks to months.

Reference: BHIVA 2022 – IRIS; BAD 2023 – Dermatological IRIS in HIV