When Should ART Be Initiated in Patients with OIs?

The most beneficial time to initiate antiretroviral therapy (ART) in patients with opportunistic infections (OIs) is still debated. This issue arises frequently in the U.S. because HIV infection is often not identified until a first OI arises, but it has even greater relative importance in resource-limited settings, where late presentation with tuberculosis or cryptococcal meningitis is common. Now, data on this topic are available from several randomized, controlled trials (including SAPiT, which is described elsewhere in this report).

In Zimbabwe, Azure Makadzange and colleagues randomized 54 HIV-infected patients with newly diagnosed cryptococcal meningitis to either start nevirapine/d4T/3TC within 72 hours or delay ART for 10 weeks [Abst…