When to start ART in the setting of acute AIDS-related opportunistic infections: the time is now!
Despite the substantial benefits of combination antiretroviral therapy (ART), a significant proportion of HIV-infected individuals still present with advanced disease and active AIDS-related opportunistic infections (OIs). The weight of evidence from recent studies supports the early initiation of ART (ie, within 2 weeks of initiating treatment for the acute OIs). Initiating ART early in acutely ill patients can reduce AIDS-related progression and death. Early ART has not been associated with increased rates of immune reconstitution inflammatory syndrome in prospective studies of non-tuberculosis OIs, although this concern is frequently cited as a reason to delay ART. Nor has early ART been associated with increased adverse outcomes. Nonetheless, initiating ART early in acute care settings can be challenging to implement and requires a well-coordinated multidisciplinary team with expertise in ART management.
Stanford University, Stanford, CA, USA. pmgrant@stanford.edu
Philip M
PM
Grant
Andrew R
AR
Zolopa
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D000208:Acute Disease; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy* / Q000276:immunology; D016720:Pneumocystis Infections / Q000188:drug therapy* / Q000276:immunology; D045363:Pneumocystis carinii / Q000276:immunology*; D013997:Time Factors
D019380:Anti-HIV Agents