IRIS

The HIV virus attacks the immune system of it’s host.  The longer the patient has HIV the more difficult it becomes to recognize other infections the patient gets and then successfully eradicate them.  After the patient is started on HIV medications his/her immune system becomes stronger and suddenly realizes there are other infections present and begins to attack them.  Patients may develop fevers, cough, sweats and other symptoms depending on which infections are present and where.  IRIS, Immune Reconstitution Inflammatory Syndrome, is what we call this when the Immune System awakens and responds.  Tuberculosis and Toxoplasmosis are 2 infections that frequently become evident with IRIS.
 
Brunhilda is a 33 year old patient who was started on HIV medications 3 weeks ago.  After 10 days of medication she developed pneumonia with high fever, headache, cough and night sweats.  She has IRIS and is currently being evaluated for Tuberculosis as the cause of her pneumonia.  Despite treatment she continues to experience high fevers further increasing our suspicion of TB.  

Brunhilda’s Fever chart, 37.0 centigrade normal