When Should ART Be Started in HIV-Infected Patients with Cryptococcal Meningitis?

Increasingly, studies have suggested benefit from early initiation of antiretroviral therapy (ART) after diagnosis of an opportunistic infection, including tuberculosis (NEJM JW AIDS Clin Care Jun 22 2009). However, early ART is seemingly not beneficial for patients with tuberculous meningitis, and the evidence remains mixed for those with cryptococcosis. In a recent trial conducted in Uganda and South Africa, researchers investigated the timing of ART initiation in HIV-infected patients with cryptococcal meningitis.

The 177 participants received induction therapy with 2 weeks of amphotericin B and high-dose fluconazole, followed by consolidation therapy with fluconazole. After 7 to 11 days of antifungal treatment, they were randomized to re…