Management and Treatment
- Clinicians should initiate appropriate treatment of OIs, as well as symptomatic treatment and supportive care according to the severity of IRIS. (A3)
- Clinicians should not interrupt antiretroviral therapy (ART) except in severe, life-threatening cases of IRIS. (A3)
- Clinicians should not use prednisone to prevent IRIS in patients with low CD4 counts who do not have active TB. (A3)
Severe IRIS
- Clinicians should consult with an experienced HIV care provider for the management of severe IRIS, including the decision of whether to interrupt ART if IRIS is severe. (A3)
- Clinicians should treat patients with severe IRIS that is not caused by either cryptococcal meningitis or KS with 1 to 2 mg/kg prednisone, or the equivalent, for 1 to 2 weeks, followed by a period of tapering dose that is individualized. (B3)
- Clinicians should not use corticosteroids for management of cryptococcal meningitis or in patients with KS. (A2)
- Clinicians should closely monitor patients receiving corticosteroids for the development of OIs, including CMV retinitis and TB disease. (A3)
