Overview, When to Start ART
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://iversity.org/en/courses/management-of-hiv-and-co-infections
When to start ART
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 Where very close monitoring and optimal treatment are available, ART could be initiated early in selected cases |
| Cryptococcal meningitis | Defer initiation of ART for at least 4 weeks |
Corticosteroids are not recommended as adjuvant treatment Where very close monitoring and optimal treatment are available, earlier ART start could be considered in selected cases |