A Nay Vote for Early Antiretroviral Therapy in Patients with Cryptococcal Meningitis

In Zimbabwe, early ART was associated with dramatically increased mortality — but how applicable are these results to other regions?

Two trials — AIDS Clinical Trials Group study A5164 and the SAPiT trial — support early rather than deferred antiretroviral therapy (ART) in patients with HIV-related opportunistic infections (OIs). However, concern remains about starting ART early for individuals with central nervous system–related OIs, because the induction of immune reconstitution inflammatory syndrome (IRIS) could potentially worsen outcomes or even be fatal. This study from Zimbabwe (previously described at CROI 2009) explores the optimal timing of ART for patients with HIV-related cryptococcal meningitis.

All study participants initiated fluconazole (800 mg daily) immediately after their meningitis diagnosis and were randomized to receive d4T/3TC/nevirapine within the …

Reviewing Author

Paul E. Sax, MD

Disclosures

Consultant/Advisory BoardGilead Sciences; GlaxoSmithKline/ViiV; Merck; Shionogi

Grant/Research SupportNIH; Gilead Sciences; ViiV

Editorial BoardsUpToDate; Clinical Infectious Diseases

Paul E. Sax, MD

Disclosures

Consultant/Advisory BoardGilead Sciences; GlaxoSmithKline/ViiV; Merck; Shionogi

Grant/Research SupportNIH; Gilead Sciences; ViiV

Editorial BoardsUpToDate; Clinical Infectious Diseases

A Nay Vote for Early Antiretroviral Therapy in Patients with Cryptococcal Meningitis

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Reviewing Author