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Management of Immune Reconstitution Inflammatory Syndrome in AIDS-Associated Kaposi Sarcoma
Source: Kaposi Sarcoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 7, 2025 · Captured 2026-09-09.
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Context: Treatment of AIDS-Associated Kaposi Sarcoma
Immune reconstitution inflammatory syndrome (IRIS) is a hyperimmune response in patients with HIV/AIDS within the first 6 months of starting antiretroviral therapy. Kaposi sarcoma (KS)-associated IRIS (KS-IRIS) is not well-defined, but is considered to be the sudden clinical worsening of previous KS ("paradoxical") or the new presentation of KS (“unmasked”) in close proximity to starting or modifying antiretroviral therapy.[26]
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Estimates for KS-IRIS incidence vary from 2% to 39%, with the highest risk in patients with any of the following characteristics:[26,27]
High HIV viral loads (>10,000 copies/mL).
CD4 lymphocyte count less than 200 cells/µL.
Detectable plasma human herpesvirus 8 DNA.
Pulmonary KS involvement.
Recent steroid use.
KS-IRIS typically presents with increased swelling/tenderness of lesions, new or worsening edema, and visceral or pulmonary involvement.
Management of KS-IRIS typically includes continuing antiretroviral therapy and initiating systemic treatment, such as liposomal doxorubicin or paclitaxel, for KS. The evidence for use of chemotherapy to prevent KS-IRIS is mixed, but can be considered on an individual basis.[26] Glucocorticoids are avoided due to the risk of dramatic worsening of KS.[27,28] Thalidomide has also been used for steroid-refractory IRIS.[29]
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Preserved source evidence · Not medical advice