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Corticosteroids for IRIS — SCE Infectious Diseases MCQ

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ModerateHIV MedicineCorticosteroids for IRISSCE Infectious Diseases

A 42-year-old woman with HIV on ART develops Immune Reconstitution Inflammatory Syndrome (IRIS) affecting her lungs — worsening pulmonary infiltrates with fever despite effective ART (VL declining, CD4 rising). She was previously treated for Pneumocystis jirovecii pneumonia. When are corticosteroids indicated for IRIS?

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Correct answer: C — When IRIS is severe (causing significant morbidity, organ dysfunction, or threat to life) — Prednisolone 1–2 mg/kg tapered over 2–4 weeks

Corticosteroids for IRIS are indicated when symptoms are severe (significant organ dysfunction, airway compromise, worsening respiratory failure). The Prednisolone IRIS (PredART) trial demonstrated benefit in TB-IRIS, and the principle extends to severe IRIS from other pathogens. Typical regimen: Prednisolone 1–1.5 mg/kg/day for 2 weeks then taper over 2–4 weeks. ART should ALWAYS be continued during IRIS treatment. Mild IRIS is managed symptomatically without corticosteroids. NSAIDs can help with mild inflammatory symptoms.

Reference: BHIVA 2022 – IRIS guidelines; PredART Trial 2018 – NEJM