Purpose: Immune reconstitution inflammatory syndrome (IRIS) can occur in Human Immunodeficiency Virus (HIV) patients after commencing antiretroviral therapy (ART). Pneumocystis jirovecii pneumonia (PJP) IRIS accounts for 2.7%–4% of IRIS cases. The prognosis and management of IRIS is well studied in other opportunistic infections but is ill defined for PJP IRIS, and no guidelines exist.

Method: A literature search was performed, and the following databases were searched: Web of Science, MEDLINE, EMBASE, SCOPUS, and grey literature sources for publications reporting cases of PJP – IRIS between January 1981 to January 2023. We also surveyed the Australasian Infectious Diseases community using the “OzBug” email forum for unpublished cases. Epidemiologic and clinical data was extracted. We provide a narrative synthesis of included publications evaluating epidemiology, mortality, and therapeutic options.

Results: Fifty patients were identified from 24 data sources comprising of: 22 journal publications, one case at our hospital and three cases contributed from OzBug. Of the 50 patients, 4 were female, 32 were male and patient sex was not documented in 13. Age range was 24–57 years. Two mortalities were described. 22% of cases of PJP-IRIS required ICU support. Antimicrobial treatment for PJP was given in 32 cases, with trimethoprim-sulfamethoxazole being most prescribed, duration of therapy ranged from 9 days to 32 days. ART was continued in the majority of cases. Corticosteroids were given in 26 (52%), cases, not given in 11 cases (20%) and not stated in 13 cases (26%). Type and dose of steroid used was described in 15 cases and exhibited broad variability.

Conclusions: A requirement for ICU care appears high, whilst mortality appears low in PJP-IRIS. Prompt treatment with steroids at a dose proportionate to disease severity is beneficial. Antimicrobial duration did not appear to impact outcome.