{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.immune-reconstitution-inflammatory-syndrome","code":"thing-q539986","url":"https://ver.cy/models/thing/q539986/","name":"immune reconstitution inflammatory syndrome","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Cross-cutting context","entryKind":"thing","plane":"XCT","domain":["XCT.STA"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory disorder in which recovery of immune function, most commonly after starting antiretroviral therapy in a person with HIV, produces clinical deterioration associated with a previously recognized or previously occult infection or other antigenic stimulus.","purpose":"Enable an agent to recognise a possible immune reconstitution inflammatory syndrome, assess its attribution and severity, and support clinician-reviewed decisions without treating temporal association as diagnostic proof.","scope":{"in":["Evidence connecting inflammatory deterioration to immune restoration","Paradoxical versus unmasking presentation and unresolved classifications","Associated disease or antigenic trigger and affected anatomical sites","Diagnostic criteria, competing explanations and attribution confidence","Severity, longitudinal course and clinician-reviewed management constraints"],"out":["The patient's complete health record","HIV infection or another underlying immunodeficiency as an independent condition","The complete model of an associated infection, malignancy or inflammatory disease","Antiretroviral, antimicrobial or immunosuppressive drug specifications","Visits, admissions and other episodes of care","Immune recovery without a pathological inflammatory syndrome"],"boundaries":[]},"distinguishingFeatures":["Require evidence of inflammatory illness linked to immune restoration; chronology alone is insufficient.","Distinguish worsening of previously recognised disease from inflammatory emergence of previously unrecognised disease when classifying paradoxical and unmasking presentations. [NIH IRIS definition](https://clinicalinfo.hiv.gov/en/glossary/immune-reconstitution-inflammatory-syndrome-iris)","Record how disease progression, new infection and drug reactions were evaluated before attributing deterioration to IRIS. [NYSDOH AI diagnostic recommendations](https://www.hivguidelines.org/snippet/art-iris-presentation-and-diagnosis-of-iris-recs-draft-copy/)","Do not require a particular peripheral CD4 increase as a universal recognition test. [NYSDOH AI IRIS guideline](https://www.hivguidelines.org/guideline/hiv-iris/)","Distinguish the inflammatory syndrome from the underlying disease, the clinician's diagnostic assertion and the encounter in which it was assessed."],"structure":{"bundles":[{"id":"syndrome-identity-and-criteria","name":"Syndrome identity and criteria","description":"Defines what qualifies as an IRIS occurrence and how that judgement is represented.","layers":[{"id":"condition-and-assertion-boundaries","name":"Condition and assertion boundaries","description":"Separates the syndrome from the records describing it.","findings":[{"id":"iris-occurrence-boundary","name":"IRIS occurrence boundary","description":"Record the inflammatory occurrence independently of patient identity, underlying disease and care encounter.","questions":[{"text":"What observed inflammatory deterioration is being considered an occurrence of IRIS?","id":"iris-occurrence-boundary-q01","kind":"definition"},{"text":"Which records represent the underlying disease, diagnostic assertion and care encounter rather than the syndrome itself?","id":"iris-occurrence-boundary-q02","kind":"boundary"}]}]},{"id":"criteria-and-terminology","name":"Criteria and terminology","description":"Makes the diagnostic and coding basis inspectable.","findings":[{"id":"versioned-diagnostic-basis","name":"Versioned diagnostic basis","description":"Attach the exact criteria and terminology release to each classification; leave unverified mappings unresolved.","questions":[{"text":"Which issuing body, criteria version and target population support this IRIS classification?","id":"versioned-diagnostic-basis-q01","kind":"provenance"},{"text":"Which criteria are met, unmet or unknown, and who assessed them?","id":"versioned-diagnostic-basis-q02","kind":"definition"},{"text":"Which verified ICD or SNOMED CT concept applies, and what release and jurisdiction qualify the mapping?","id":"versioned-diagnostic-basis-q03","kind":"provenance"}]}]}]},{"id":"immune-restoration-and-timing","name":"Immune restoration and timing","description":"Connects the inflammatory event to the proposed restoration of immune function.","layers":[{"id":"restoration-trigger","name":"Restoration trigger","description":"Identifies the transition proposed to precede IRIS.","findings":[{"id":"documented-restoration-context","name":"Documented restoration context","description":"Capture the treatment or physiological transition and check whether the chosen framework covers it.","questions":[{"text":"What dated event is proposed to have restored immune function?","id":"documented-restoration-context-q01","kind":"provenance"},{"text":"Does the selected IRIS framework cover this HIV-related or other restoration context?","id":"documented-restoration-context-q02","kind":"boundary"}]}]},{"id":"temporal-and-biological-evidence","name":"Temporal and biological evidence","description":"Records chronology and context-appropriate evidence of recovery.","findings":[{"id":"recovery-inflammation-sequence","name":"Recovery-inflammation sequence","description":"Retain baseline and follow-up observations with their dates and uncertainty.","questions":[{"text":"How many days separate the restoration event, first inflammatory symptoms and diagnostic assessment?","id":"recovery-inflammation-sequence-q01","kind":"measurement"},{"text":"What immune or virological measurements support recovery, and when were they obtained?","id":"recovery-inflammation-sequence-q02","kind":"measurement"},{"text":"How does missing or discordant recovery evidence affect attribution under the selected criteria?","id":"recovery-inflammation-sequence-q03","kind":"boundary"}]}]}]},{"id":"presentation-and-associated-disease","name":"Presentation and associated disease","description":"Relates presentation type to the disease history and inflammatory target.","layers":[{"id":"prior-disease-status","name":"Prior disease status","description":"Reconstructs disease recognition and treatment before immune restoration.","findings":[{"id":"presentation-classification-evidence","name":"Presentation classification evidence","description":"Record the history supporting the selected presentation category and preserve ambiguity.","questions":[{"text":"Was the associated disease recognised before immune restoration, and what evidence establishes that history?","id":"presentation-classification-evidence-q01","kind":"provenance"},{"text":"What treatment and clinical response preceded the inflammatory deterioration?","id":"presentation-classification-evidence-q02","kind":"measurement"},{"text":"What supports paradoxical IRIS, unmasking IRIS or an indeterminate classification in this occurrence?","id":"presentation-classification-evidence-q03","kind":"definition"}]}]},{"id":"inflammatory-target","name":"Inflammatory target","description":"Links the syndrome to its proposed disease or antigenic driver.","findings":[{"id":"trigger-and-site-attribution","name":"Trigger and site attribution","description":"Separate an established associated disease from a hypothesised inflammatory trigger.","questions":[{"text":"Which disease or antigenic trigger is implicated, and what microbiological, pathological or clinical evidence supports it?","id":"trigger-and-site-attribution-q01","kind":"provenance"},{"text":"Which anatomical sites show inflammation, and how do they relate to the known disease distribution?","id":"trigger-and-site-attribution-q02","kind":"measurement"}]}]}]},{"id":"differential-and-attribution","name":"Differential and attribution","description":"Organises competing explanations and the strength of the IRIS judgement.","layers":[{"id":"competing-disease-processes","name":"Competing disease processes","description":"Tests whether the observed deterioration has another explanation.","findings":[{"id":"alternative-cause-assessment","name":"Alternative cause assessment","description":"Record supporting, contradicting and missing evidence for each plausible alternative.","questions":[{"text":"What evidence addresses progression or relapse of the associated disease, a new infection or a drug reaction?","id":"alternative-cause-assessment-q01","kind":"boundary"},{"text":"Where relevant, have adherence, drug exposure and antimicrobial resistance been assessed as explanations for treatment failure?","id":"alternative-cause-assessment-q02","kind":"provenance"},{"text":"Which unresolved alternative requires further investigation before attribution can strengthen?","id":"alternative-cause-assessment-q03","kind":"action"}]}]},{"id":"attribution-confidence","name":"Attribution confidence","description":"Keeps diagnostic confidence revisable.","findings":[{"id":"reviewable-iris-judgement","name":"Reviewable IRIS judgement","description":"Preserve the assessor's reasoning and avoid forcing coexisting causes into a single explanation.","questions":[{"text":"Who attributed the deterioration to IRIS, on what date and with what explicit uncertainty?","id":"reviewable-iris-judgement-q01","kind":"provenance"},{"text":"Could IRIS coexist with active disease or treatment failure in this occurrence?","id":"reviewable-iris-judgement-q02","kind":"boundary"},{"text":"What new evidence would trigger reassessment or withdrawal of the IRIS diagnosis?","id":"reviewable-iris-judgement-q03","kind":"action"}]}]}]},{"id":"organ-impact-and-course","name":"Organ impact and course","description":"Captures the consequences and evolution of the inflammatory syndrome.","layers":[{"id":"severity-and-urgent-features","name":"Severity and urgent features","description":"Connects symptoms and objective findings to functional consequences.","findings":[{"id":"organ-threatening-inflammation","name":"Organ-threatening inflammation","description":"Record site-specific dysfunction and the clinical basis for urgency.","questions":[{"text":"What observations establish the degree of neurological, visual, respiratory or other organ impairment?","id":"organ-threatening-inflammation-q01","kind":"measurement"},{"text":"Which documented findings require urgent assessment under the applicable clinical guidance?","id":"organ-threatening-inflammation-q02","kind":"action"}]}]},{"id":"longitudinal-outcome","name":"Longitudinal outcome","description":"Tracks inflammation separately from immune recovery and associated disease activity.","findings":[{"id":"course-and-resolution-evidence","name":"Course and resolution evidence","description":"Use dated observations to support worsening, improvement, resolution or recurrence.","questions":[{"text":"Which symptoms, examination findings, laboratory measures or imaging findings changed over time?","id":"course-and-resolution-evidence-q01","kind":"measurement"},{"text":"What evidence supports resolution or recurrence, and what residual impairment remains?","id":"course-and-resolution-evidence-q02","kind":"definition"},{"text":"Does the observed course require reconsidering the original attribution?","id":"course-and-resolution-evidence-q03","kind":"action"}]}]}]},{"id":"management-context-and-review","name":"Management context and review","description":"Links clinical decisions to the associated disease, severity and applicable guidance.","layers":[{"id":"guidance-applicability","name":"Guidance applicability","description":"Identifies the evidence relevant to the particular presentation.","findings":[{"id":"disease-specific-decision-basis","name":"Disease-specific decision basis","description":"Attach current, population-appropriate guidance to each proposed management decision.","questions":[{"text":"Which guideline and version address this associated disease, organ involvement and immune restoration context?","id":"disease-specific-decision-basis-q01","kind":"provenance"},{"text":"What patient or presentation features limit the applicability of its recommendations?","id":"disease-specific-decision-basis-q02","kind":"boundary"}]}]},{"id":"clinician-decisions-and-follow-up","name":"Clinician decisions and follow-up","description":"Records authorised actions, their rationale and reassessment conditions.","findings":[{"id":"reviewed-management-plan","name":"Reviewed management plan","description":"Link decisions about associated disease treatment, immune restoration therapy and inflammation control to responsible clinicians.","questions":[{"text":"What management decisions were made, by whom and on what disease-specific evidence?","id":"reviewed-management-plan-q01","kind":"action"},{"text":"What clinical changes or pending results will trigger review of those decisions?","id":"reviewed-management-plan-q02","kind":"action"},{"text":"What follow-up observations will distinguish inflammatory improvement from progression of the associated disease?","id":"reviewed-management-plan-q03","kind":"measurement"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-standards-and-regulation","name":"Standards and regulation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these standards and regulation hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-standards-and-regulation-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-regional-variation","name":"Regional variation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these regional variation hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-regional-variation-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of immune reconstitution inflammatory syndrome this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain IRIS in general terms from reputable medical sources.","Encourage a person who feels worse after starting HIV treatment to contact their clinic rather than stop treatment."],"mustNot":["Advise anyone to stop or delay antiretroviral therapy.","Diagnose IRIS or the infection behind it for a specific person.","Disclose a person's HIV status without consent.","Use the syndrome to cast doubt on the value of HIV treatment."],"requiresHuman":["Treatment decisions, including timing of HIV and infection therapy."]},"ethics":{"considerations":["HIV status is highly sensitive; disclosure can lead to discrimination and violence.","Misinformation about treatment side effects can lead people to stop life-saving therapy."],"affectedParties":["People living with HIV","Their partners and families","Health workers"]},"owners":{"steward":"Nobody owns the syndrome; patients and their clinicians answer for care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q3843811","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.immune-reconstitution-inflammatory-syndrome","Wikidata: Q539986 (https://www.wikidata.org/wiki/Q539986)"]},"properties":{"applicability":"not-applicable","items":["Immune restoration context: ART initiation, reinitiation or change; other documented restoration context; uncertain","Inflammatory onset interval: Days from the specified immune restoration event, with date uncertainty","Presentation classification: Paradoxical; unmasking; indeterminate; framework-specific other","Associated disease or antigenic trigger: Linked disease or trigger record with evidence status and anatomical site","Diagnostic assertion status: Suspected; supported under named criteria; disputed; excluded; reassessed","Diagnostic framework: Criteria title, issuing body, version or date, population and source","Immune and virological trajectory: Dated CD4 counts in cells/µL and HIV RNA in copies/mL where applicable; context-specific recovery measures otherwise","Organ involvement and severity: Affected sites, observed dysfunction, urgent features and severity under a named assessment method","Inflammatory course: Emerging; worsening; stable; improving; resolved; recurrent; uncertain"]},"recognition":{"applicability":"not-applicable","items":[]},"capabilities":{"applicability":"required","items":["Construct an evidence-linked timeline of immune restoration, disease treatment and inflammatory deterioration.","Compare an occurrence with applicable diagnostic criteria and identify unmet or unknown requirements.","Surface competing explanations and unresolved investigations for clinician review.","Flag documented organ-threatening deterioration for urgent clinical assessment.","Retrieve disease-specific management guidance with its version and applicability.","Track response and revise attribution as subsequent evidence becomes available."]},"hazards":{"applicability":"required","items":["Can cause sudden worsening of tuberculosis or other infections.","Severe inflammation in the brain can be life-threatening."]},"interfaces":{"applicability":"required","items":["Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring, World Health Organization."]},"context":{"applicability":"required","items":["This syndrome is considered during clinical assessment of inflammatory deterioration after immune recovery associated with HIV treatment.","It helps frame investigation of worsening known infections or newly apparent infections while alternative explanations remain under consideration."]}},"sources":[{"title":"Wikidata item Q539986: immune reconstitution inflammatory syndrome","url":"https://www.wikidata.org/wiki/Q539986","note":"identity and sense of the item"},{"title":"Wikipedia: Immune reconstitution inflammatory syndrome","url":"https://en.wikipedia.org/wiki/Immune_reconstitution_inflammatory_syndrome","note":"general description of the item"}],"openQuestions":["Which general and disease-specific IRIS case definitions should be supported, and how should disagreements between their versions be represented?","How broadly should this registry entry cover non-HIV immune restoration syndromes, and which contexts require separate applicability rules?","Which ICD-10 jurisdictional variants, ICD-11 releases and SNOMED CT editions provide verified mappings, and are those mappings exact or broader?","What population-, associated-disease- and year-specific incidence or prevalence estimates are defensible, with explicit denominators and case definitions?","Which severity, resolution and recurrence definitions are validated across presentations, and where must the model retain disease-specific judgements?"],"resources":{"spec":"/models/things/publications/thing-q539986/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q539986/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T10:26:03Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"not-applicable","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:31+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane XCT: no invented physical properties.","interaction.recognition":"The syndrome has no distinctive visual identity because observable inflammatory signs overlap with other conditions and attribution requires clinical assessment."},"score":1.0}}