Opportunistic Infections and COVID-19, Overview

Opportunistic Infections and COVID-19, 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 
  • Overview of Management of COVID-19 in PLWH

See online video lectures Tuberculosis and HIV Co-infection-Part 1 and Tuberculosis and HIV Co-infection-Part 2 from the EACS online course Management of HIV and Co-infections

When to start ART

When to start ART in PLWH 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

As soon as possible within two weeks of starting TB treatment, regardless of CD4 count

ART should be delayed for 4 weeks, but can be initiated within the first 2 weeks in PLWH with TB meningitis and CD4 < 50 (100) cells/μL

For details, see ART in TB/HIV Co-infection 

Corticosteroids are recommended as adjuvant treatment for TB meningitis

Cryptococcal meningitis Defer initiation of ART for at least 4 weeks (WHO recommends a delay of 4-6 weeks and some specialists recommend a delay of 6-10 weeks in severe cryptococcal meningitis) Corticosteroids are not recommended as adjuvant treatment