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A randomized controlled trial (RCT) in Africa demonstrated worse outcomes in HIV-infected persons with cryptococcal meningitis (CM) who started on antiretroviral therapy (ART) within 1–2 weeks of CM diagnosis compared with ≥5 weeks (NEJM 2014; 370:2487), leading to a recommendation to delay ART until after the first 5 weeks of CM treatment. However, no RCTs are available from high-income settings, and it's possible that outcomes may differ based on local resources.
Investigators analyzed data from 30 clinical HIV cohorts in Europe and North America that included adult persons with HIV (PWH) and a diagnosis of CM from 1994 to 2012. Among 1387 PWH with CM, 1197 (86%) were excluded (256 of whom had no follow-up). Data from the remaining 190 sub…