Caused by an inflammatory response from an improving immune system to an infective organism(s) that had previously colonized the body resulting in a small number of patients getting worse after starting treatment
| Presentation | Infective causes | Investigations | Treatment |
|---|---|---|---|
| Paradoxical clinical deterioration after starting ART Usually within the first 6 weeks or 3 months after start of ART Presentation dependent on causative organism |
Wide range: e.g. TB, Cryptococcal meningitis, KS, hepatitis |
Mainly clinical Supportive findings: increased CD4 count after start of ART increased immune response specific to pathogen (e.g. positive Mantoux) |
Specific antimicrobial treatment if not already on this.
In severe reactions consider steroids 1 and/or even temporarily stopping ART2 |
1 prednisone 1mg/kg/day for 10-21 days
2 always discuss with consultant first