Adverse effects of antiretroviral therapy or another disease?

Abstract

The immune reconstitution inflammatory syndrome (IRIS) is a paradoxical inflammatory response that can occur in patients infected with the human immunodeficiency virus (HIV) in the first weeks after initiating antiretroviral therapy (ART). It can be manifested either by exposing an underlying infection, or by aggravating the symptoms of an opportunistic infection already diagnosed and under treatment. We present the case of a 24-year-old patient, diagnosed in September 2019 with HIV infection category C3. Extrapulmonary tuberculosis with lymph node and probably splenic metastases. Bacteremia with Staphylococcus aureus. Normocytic hypochromic anaemia – medium form. Antibacillary therapy and ART were initiated (10 days after treatment for tuberculosis). After about 2 weeks from the initiation of ART, the patient complained of intense lumbar pain with irradiation in the lower limbs. IRIS (bone tuberculosis) or a bone adverse reaction to ART was suspected, but the imaging examination (MRI-lumbar spine) reveals a lumbosacral disc herniation, the patient continuing ART, antibacillary treatment, adding neurological treatment. Conclusions. IRIS should be considered in patients diagnosed with HIV in late stages, in which the introduction of ART may be followed by the aggravation or occurrence of an opportunistic infection posing a problem of treatment and differential diagnosis.

Keywords

• immune reconstitution inflammatory syndrome
• hiv
• tuberculosis
• antiretroviral therapy