Guidelines>Zambia HIV National Guidelines>

• 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

• 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

• 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.

REFERENCED WITHIN THIS GUIDE

• Baseline evaluation and Monitoring
• Treatment Failure