OI Overview & When to Start ART

Opportunistic Infections and Other Co-infections

This section provides:

Recommendations for timing on ART initiation in persons with OIs without prior ART exposure
Overview of IRIS and recommendations on its management
Overview of the most important aspects in management of the most frequent OIs occurring in persons with HIV in Europe
Overview of management of COVID-19 in persons with HIV
Overview of management of Mpox in persons with HIV
Please note that additional infections presented in other sections of these guidelines (e.g. sexually-transmitted infections) may be more severe and/or have atypical presentations in people with advanced HIV infection. Please refer to the appropriate sections for management and treatment

See online videos for selected opportunistic infections in the EACS online course
https://www.eacsociety.org/education/online-course/

When to start ART in Persons with Opportunistic Infections (OIs)

	Initiation of ART	Comments
General recommendation	As soon as possible within 2 weeks after starting treatment for the opportunistic infection
TB meningitis	In persons with CD4 < 50 cells/μL, ART should be initiated within the first 2 weeks after initiation of TB treatment, if close monitoring and optimal TB treatment can be ensured ART initiation should be delayed for 4 weeks in all other cases	Corticosteroids are recommended as adjuvant treatment. For further discussion see Diagnosis and Treatment of TB in Persons with HIV Earlier ART start in selected patients could be considered in settings where very close monitoring and optimal treatment are available
Cryptococcal meningitis	Delay ART initiation for 4-6 weeks	Corticosteroids are not recommended as adjuvant treatment Earlier ART start in selected patients could be considered in settings where very close monitoring and optimal treatment are available