to several months or even years after ART initiation. The following table describes the major and minor presentations in reported underlying OIs. Diagnosis The diagnosis of IRIS is clinical. There is no universal definition of IRIS, however there is general consensus that most of the following criteria should be met to make the diagnosis: Presence of AIDS with low pretreatment CD4 count, typically <100 cells/microL. An exception is in the setting of Mycobacterium tuberculosis infection, which can be reactivated with CD4 cells >200 cells/microL. Decrease in HIV-1 RNA levels from baseline or increase in CD4 count after starting ART No evidence of drug-resistant infection, bacterial superinfection, adverse drug reaction, patient non-adherence, or reduced serum drug levels (from drug-drug interactions or malabsorption). Clinical symptoms consistent with an inflammatory condition Temporal association between initiation of ART and symptom onset The differential diagnosis of IRIS is broad given its varied presentation. Conditions that can present similarly to IRIS are: adverse drug effects, progression of initial OI caused by medication resistance or patient non-adherence, and development of a new OI. Management Mild IRIS For mild symptoms, treatment is focused on treating the underlying infection and symptom management. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to alleviate inflammatory symptoms, such as fever or pain. Abscess drainage, excision of painful and inflamed lymph nodes, and inhaled corticosteroids for bronchospasm from mild pulmonary inflammation may also be used when indicated. Severe IRIS In severe IRIS, symptoms may cause permanent disability or death. Management again includes antimicrobial treatments against the underlying infection. Corticosteroids are the most commonly used intervention in these cases as they work to suppress the inflammatory response seen in IRIS, though there is limited research on their efficacy. Guidelines recommend a risk/benefit analysis prior to starting corticosteroids, especially taking into consideration the patient’s comorbidities. Common adverse effects of corticosteroids are hyperglycemia, hypertension, mental status changes, worsening of an existing infection, and increased risk of a new infection. Important exceptions include cases of Cryptococcal-IRIS with worsening meningitis symptoms (cranial nerve defects, hearing or vision changes) and cases of Kaposi's sarcoma. In these cases, corticosteroids should not be used as they have been shown to worsen outcomes. It is recommended to continue ART except in the most severe cases of IRIS. Discontinuing ART may be considered in life-threatening cases of IRIS not improved by corticosteroids, usually in central nervous system-associated IRIS. Stopping ART increases the risk of