Figure 1. Clinical spectrum of 139 IRIS events by mode of presentation (paradoxical or unmasking) and underlying diagnosis.

* Features of oesophagitis IRIS were odynophagia with significant anorexia, endoscopic findings, or haematemesis, with a clinical course consistent with paradoxical or unmasking IRIS and not typical of reflux or other common causes. ** The strongyloides IRIS case was unusual in its severity (it was diagnosed post mortem); the arguments that this case was IRIS have been published in a case report [67]. *** Based on clinical evidence of genital ulcer disease (GUD), pre-ART serologic evidence of herpes simplex virus (HSV)-2 infection, and exclusion of syphilis or confirmation of HSV-2 by polymerase chain reaction on ulcer swab. A diagnosis of unmasking HSV-IRIS was based on new onset GUD despite pre-ART serologic evidence of herpes simplex virus (HSV)-2 infection. A diagnosis of paradoxical HSV-IRIS was based on increasing frequency and/or severity of episodes of known recurrent genital herpes, relative to pre-ART. Anti-herpetic therapy was not available in this setting. **** Genital, orolabial or generalised warts. Unmasking IRIS involving genital warts was supported by a history of sexual abstinence since prior to ART initiation. ***** Intra-oral pain and ulceration (n = 6), or extra-oral ulceration (n = 3, one involving most of the face), with virological confirmation of HSV-1 by polymerase chain reaction, or no other likely causative organism. ****** Features suggestive of tinea IRIS were: unusually rapid spread of lesions, or marked inflammation. There were 18 more “typical” non-IRIS tinea cases that occurred during an interruption in ART, or where clinical history was insufficient to support an IRIS diagnosis.