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HIV immune reconstitution TB — DTM&H MCQ

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ModerateHIV/AIDS in tropical settingsHIV immune reconstitution TBDTM&H

A man with advanced HIV starts ART 2 weeks after TB treatment. He develops fever, enlarging lymph nodes and worsening radiographic infiltrates despite adherence. What is the most likely diagnosis?

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Correct answer: C — Paradoxical TB immune reconstitution inflammatory syndrome

Paradoxical TB immune reconstitution inflammatory syndrome is the single best answer because worsening inflammatory TB manifestations soon after ART initiation can represent paradoxical IRIS. TB treatment failure from non-adherence is plausible in a related presentation, but it is less appropriate because it does not fit the key discriminator in this vignette. The teaching point is that drug resistance and alternative diagnoses still need assessment, especially if deterioration is severe.

Reference: WHO consolidated HIV guidelines; WHO advanced HIV disease guidance; Manson's Tropical Diseases