Opportunistic Infections, Overview

Opportunistic Infections, When to Start ART

This section provides:

  • Recommendations for timing on ART initiation in PLWH with OIs without prior ART exposure
  • See IRIS and recommendations on its management
  • Overview of the most important aspects in management of the most frequent OIs occurring in PLWH in Europe

For more detailed discussion, we refer to national guidelines

See online video lectures HIV and the Management of IRIS-Part 1, HIV and the Management of IRIS-Part 2, HIV and Pulmonary Infections-Part 1, HIV and Pulmonary Infections-Part 2, HIV and Pulmonary Infections-Part 3, CNS and HIV-related opportunistic infections-Part 1, CNS and HIV-related opportunistic infections-Part 2, Tuberculosis and HIV Co-infection-Part 1 and Tuberculosis and HIV Co-infection-Part 2 from the EACS online course Clinical Management of HIV

When to start ART

When to start ART in PLWH with opportunistic infections

  CD4 count Initiation of ART Comments
General recommendation Any As soon as possible and within 2 weeks after starting treatment for the opportunistic infection  
Tuberculosis  < 50 cells/μL As soon as possible and within 2 weeks after starting TB treatment A threshold of 100 cells/μL may be more appropriate due to variability in CD4 count assessments CD4 thresholds also apply for TB meningitis – with close monitoring due to increased risk of adverse effects For details, see ART in TB/HIV Co-infection 
> 50 cells/μL Can be delayed up to 8 weeks after starting TB treatment, especially if difficulties with adherence, drug-drug-interactions or toxicity
Cryptococcal meningitis Any Defer initiation of ART for at least 4 weeks (some specialists recommend a delay of 6-10 weeks in severe cryptococcal meningitis)  
CMV end organ disease Any A delay of a maximum of 2 weeks might be considered Especially for persons with chorioretinitis and encephalitis due to risk of IRIS