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 Zambia HIV National Guidelines
 


Introduction  

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Sexually Transmitted Infections (STIs)  

General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents  

When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

Initial Regimen for ARV Therapy  

Adherence  

Baseline evaluation and Monitoring  

Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

Immune Reconstitution Inflammatory Syndrome (IRIS)  

Changing or Stopping ART  

Treatment Failure  

Stopping ARV Therapy  

Post Exposure Prophylaxis  

Cotrimoxazole Prophylaxis  

WHO Staging in Adults and Adolescents  

Nutrition Care and Support  

Palliative Care in HIV and AIDS  

 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

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Immune Reconstitution Inflammatory Syndrome (IRIS)

04-01-2008
Definition:

Immune reconstitution inflammatory syndrome (IRIS) is an

  • Exaggerated inflammatory reaction from a re-invigorated immune system presenting as "unmasking" of previously sub-clinical OIs OR clinical deterioration of pre-existing OIs OR development of autoimmune disease
Clinical

  • Onset: usually within 2-12 weeks after starting ART
  • Frequency: 10% among all pts on ART, up to 25% when ART initiated with CD4 <50
  • Risk factors: (1) Initiating ART close to Dx of an OI; (2) Initiating ART when CD4 <50; (3) Rapid initial fall in VL in response to ART in patients with low CD4 counts
  • Most commonly seen with TB, cryptococcal disease and MAC infection
Management

  • Have high index of suspicion with early complications
  • Continue ART if possible; if continuation impossible, temporarily interrupt ART and restart same regimen after OI or inflammatory condition treated
  • Treat OI or inflammatory condition
  • Symptomatic treatment with NSAIDs in patients with milder symptoms
  • Corticosteroid treatment in moderate to severe cases: prednisolone or prednisone 0.5 mg/kg/day. Slow taper may be required depending on duration of steroid treatment.

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