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KS-IRIS Management — SCE Infectious Diseases MCQ

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HardHIV MedicineKS-IRIS ManagementSCE Infectious Diseases

A 35-year-old man with HIV develops Kaposi sarcoma-associated immune reconstitution inflammatory syndrome (KS-IRIS) 6 weeks after starting ART. His KS lesions have become more inflamed, oedematous, and new lesions have appeared, despite falling VL and rising CD4. What is the management?

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Correct answer: E — Continue ART and start systemic chemotherapy (liposomal Doxorubicin) — KS-IRIS is managed by treating the KS with chemo while maintaining ART; do NOT stop ART

KS-IRIS is a unique form of IRIS where immune reconstitution paradoxically worsens KS. Unlike TB-IRIS or cryptococcal IRIS, corticosteroids are generally AVOIDED in KS-IRIS as they may worsen KS (HHV-8 replication is enhanced by corticosteroids). Management: continue ART (essential for long-term KS control) PLUS systemic chemotherapy (liposomal Doxorubicin) for the worsening KS. Stopping ART would temporarily improve KS-IRIS but at the cost of progressive immunodeficiency and ultimately worse KS outcomes.

Reference: BHIVA 2022 – IRIS; BHIVA 2022 – HIV-associated malignancy