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A recently published randomized study showed that the incidence of AIDS progression or death was lower with early initiation of antiretroviral therapy (ART) after opportunistic infection diagnosis than with delayed initiation and that the incidence of immune reconstitution inflammatory syndrome (IRIS) was not increased in those who started ART sooner (JW AIDS Clin Care Jun 22 2009). However, relatively few patients with cryptococcal meningitis (CM) were included in that study, and concerns remain regarding whether CM-IRIS might lead to substantial morbidity or mortality in patients who initiate ART early. Can we predict which patients are at highest risk for CM-IRIS?
Investigators in South Africa evaluated the incidence of and risk factors f…