Cryptococcal Meningitis Study Stopped — Early HIV Therapy Clearly Harmful

Several major clinical trials — ACTG 5164, SAPiT, STRIDE, and CAMELIA — have demonstrated that early antiretroviral therapy (ART) is beneficial in the setting of acute opportunistic infections, but cryptococcal meningitis (CM) seems to be an exception to this rule. Last week, the NIH announced that it is stopping enrollment in the COAT study — a phase IV trial on the timing of ART in HIV-infected patients hospitalized with CM — because of an interim analysis showing high mortality rates with early ART initiation. These results, consistent with those of a previous CM trial, have “immediate applicability to practice world-wide,” writes Dr. Paul Sax in his HIV and ID Observations blog. Read more here.