Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case Report
Introduction: Immune reconstitution inflammatory syndrome (IRIS) can occur in patients with advanced HIV infection shortly after initiating antiretroviral therapy (ART). Although it usually manifests between 2 and 8 weeks of treatment, earlier presentations have been described, particularly in pati...
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Universidad Nacional Hermilio Valdizán de Huánuco
2025-04-01
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| Series: | Microbes, Infection and Chemotherapy |
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| Online Access: | https://revistas.unheval.edu.pe/index.php/mic/article/view/2354 |
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| author | Jorge L. Vélez-Paez Christian Castro-Bustamante Manuel Gallegos-Paredes Erick Tutin-Miniguano Hugo A. Tirapé-Castro |
| author_facet | Jorge L. Vélez-Paez Christian Castro-Bustamante Manuel Gallegos-Paredes Erick Tutin-Miniguano Hugo A. Tirapé-Castro |
| author_sort | Jorge L. Vélez-Paez |
| collection | DOAJ |
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Introduction: Immune reconstitution inflammatory syndrome (IRIS) can occur in patients with advanced HIV infection shortly after initiating antiretroviral therapy (ART). Although it usually manifests between 2 and 8 weeks of treatment, earlier presentations have been described, particularly in patients with very low CD4 counts and high viral loads. Case Presentation: A 43-year-old male, with a CD4 count of 10 cells/µL and a viral load of 432,000 copies/mL, was admitted due to respiratory failure secondary to Pneumocystis jirovecii infection and Candida findings in tracheal secretions. ART and trimethoprim-sulfamethoxazole (TMP-SMX) were initiated on day 1, together with high-dose corticosteroids (MEDURI protocol) for severe pneumocystosis. By day 5 of ART, he developed persistent fever (up to 40 °C), leukocytosis, and elevated inflammatory markers, without new microbiological findings despite broad-spectrum antibiotic therapy. A diagnosis of possible IRIS was considered, as the fever did not subside with antimicrobial coverage and other infections were ruled out. Clinical stabilization was achieved around day 20, highlighting the importance of early recognition of IRIS in critically ill AIDS patients. Conclusions: The presence of fever and clinical deterioration in the early stages of ART necessitates ruling out active or persistent infections; however, an inflammatory dysfunction such as IRIS can also occur before 2 weeks of treatment. This case report underscores the need for close surveillance and a multidisciplinary approach to optimize the management of complications in patients with advanced AIDS.
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| format | Article |
| id | doaj-art-a25b8ea7ca9e4412838e89507d10066b |
| institution | DOAJ |
| issn | 2789-4274 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Universidad Nacional Hermilio Valdizán de Huánuco |
| record_format | Article |
| series | Microbes, Infection and Chemotherapy |
| spelling | doaj-art-a25b8ea7ca9e4412838e89507d10066b2025-08-20T03:13:40ZengUniversidad Nacional Hermilio Valdizán de HuánucoMicrobes, Infection and Chemotherapy2789-42742025-04-01510.54034/mic.e2354Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case ReportJorge L. Vélez-Paez0https://orcid.org/0000-0002-6956-4475Christian Castro-Bustamante1Manuel Gallegos-Paredes2Erick Tutin-Miniguano3Hugo A. Tirapé-Castro4Intensive Care Unit, Hospital Provincial Pablo Arturo Suárez, Quito, Ecuador; Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador; Pontificia Universidad Católica del Ecuador, Posgrado de Medicina Crítica y terapia Intensiva, Quito, EcuadorIntensive Care Unit, Hospital Provincial Pablo Arturo Suárez, Quito, EcuadorIntensive Care Unit, Hospital Provincial Pablo Arturo Suárez, Quito, Ecuador; Pontificia Universidad Católica del Ecuador, Posgrado de Medicina Crítica y terapia Intensiva, Quito, EcuadorIntensive Care Unit, Hospital Provincial Pablo Arturo Suárez, Quito, Ecuador; Pontificia Universidad Católica del Ecuador, Posgrado de Medicina Crítica y terapia Intensiva, Quito, EcuadorIntensive Care Unit, Hospital Provincial Pablo Arturo Suárez, Quito, Ecuador; Pontificia Universidad Católica del Ecuador, Posgrado de Medicina Crítica y terapia Intensiva, Quito, Ecuador Introduction: Immune reconstitution inflammatory syndrome (IRIS) can occur in patients with advanced HIV infection shortly after initiating antiretroviral therapy (ART). Although it usually manifests between 2 and 8 weeks of treatment, earlier presentations have been described, particularly in patients with very low CD4 counts and high viral loads. Case Presentation: A 43-year-old male, with a CD4 count of 10 cells/µL and a viral load of 432,000 copies/mL, was admitted due to respiratory failure secondary to Pneumocystis jirovecii infection and Candida findings in tracheal secretions. ART and trimethoprim-sulfamethoxazole (TMP-SMX) were initiated on day 1, together with high-dose corticosteroids (MEDURI protocol) for severe pneumocystosis. By day 5 of ART, he developed persistent fever (up to 40 °C), leukocytosis, and elevated inflammatory markers, without new microbiological findings despite broad-spectrum antibiotic therapy. A diagnosis of possible IRIS was considered, as the fever did not subside with antimicrobial coverage and other infections were ruled out. Clinical stabilization was achieved around day 20, highlighting the importance of early recognition of IRIS in critically ill AIDS patients. Conclusions: The presence of fever and clinical deterioration in the early stages of ART necessitates ruling out active or persistent infections; however, an inflammatory dysfunction such as IRIS can also occur before 2 weeks of treatment. This case report underscores the need for close surveillance and a multidisciplinary approach to optimize the management of complications in patients with advanced AIDS. https://revistas.unheval.edu.pe/index.php/mic/article/view/2354HIVAIDSimmune reconstitution inflammatory syndromeARTpneumocystosiscandidiasis |
| spellingShingle | Jorge L. Vélez-Paez Christian Castro-Bustamante Manuel Gallegos-Paredes Erick Tutin-Miniguano Hugo A. Tirapé-Castro Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case Report Microbes, Infection and Chemotherapy HIV AIDS immune reconstitution inflammatory syndrome ART pneumocystosis candidiasis |
| title | Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case Report |
| title_full | Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case Report |
| title_fullStr | Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case Report |
| title_full_unstemmed | Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case Report |
| title_short | Early-Onset Immune Reconstitution Inflammatory Syndrome After the Initiation of Antiretroviral Therapy in an AIDS-Stage Patient: A Case Report |
| title_sort | early onset immune reconstitution inflammatory syndrome after the initiation of antiretroviral therapy in an aids stage patient a case report |
| topic | HIV AIDS immune reconstitution inflammatory syndrome ART pneumocystosis candidiasis |
| url | https://revistas.unheval.edu.pe/index.php/mic/article/view/2354 |
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