Optimal timing for antiretroviral therapy initiation in patients with HIV infection and concurrent cryptococcal meningitis

Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas

“…In our analysis, dynamic marginal structural models did not show an increased risk of death for patients who started ART within 2 weeks after diagnosis of cryptococcal meningitis compared with those who started during weeks 2–8. Our results are consistent with a systematic review that found no difference in mortality for early versus delayed ART initiation; this review included patients in Puerto Rico, Zimbabwe, the U.S., and South Africa 14 . However, this differs from the findings of the COAT trial, which found that patients randomized to start ART within 2 weeks after diagnosis of CM had a higher risk of mortality compared to those assigned to defer ART until 5 weeks after diagnosis of CM 9 .…”

Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas

“…In our analysis, dynamic marginal structural models did not show an increased risk of death for patients who started ART within 2 weeks after diagnosis of cryptococcal meningitis compared with those who started during weeks 2–8. Our results are consistent with a systematic review that found no difference in mortality for early versus delayed ART initiation; this review included patients in Puerto Rico, Zimbabwe, the U.S., and South Africa 14 . However, this differs from the findings of the COAT trial, which found that patients randomized to start ART within 2 weeks after diagnosis of CM had a higher risk of mortality compared to those assigned to defer ART until 5 weeks after diagnosis of CM 9 .…”

The Effect of Early vs. Deferred Antiretroviral Therapy Initiation in HIV-Infected Patients With Cryptococcal Meningitis: A Multicenter Prospective Randomized Controlled Analysis in China

“…Previous studies in mixed patient cohorts or non-randomized studies have suggested that early ART treatment could decrease mortality and possibly improve clinical outcomes (1,3). However, a systematic review which included subjects from the United States, South Africa, Zimbabwe, and Puerto Rico found insufficient evidence to support either early or deferred initiation of ART (14). In another large Latin-American cohort study, there also appeared to be no statistically significant difference in the probability of survival between patients who started ART within 2 weeks of CM vs. those initiating ART between 2 and 8 weeks after CM diagnosis (15).…”

Immediate versus deferred antiretroviral therapy in HIV-infected patients presenting with acute AIDS-defining events (toxoplasmosis, Pneumocystis jirovecii-pneumonia): a prospective, randomized, open-label multicenter study (IDEAL-study)

“…Other trials with different study populations, mostly in resource poor countries and with different OI (like tuberculosis, cryptococcal meningitis) showed worse outcomes, if ART was initiated sooner, compared to deferred initiation [26, 28, 29].…”

Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas

“…In our analysis, dynamic marginal structural models did not show an increased risk of death for patients who started ART within 2 weeks after diagnosis of cryptococcal meningitis compared with those who started during weeks 2–8. Our results are consistent with a systematic review that found no difference in mortality for early versus delayed ART initiation; this review included patients in Puerto Rico, Zimbabwe, the U.S., and South Africa 14 . However, this differs from the findings of the COAT trial, which found that patients randomized to start ART within 2 weeks after diagnosis of CM had a higher risk of mortality compared to those assigned to defer ART until 5 weeks after diagnosis of CM 9 .…”

The Effect of Early vs. Deferred Antiretroviral Therapy Initiation in HIV-Infected Patients With Cryptococcal Meningitis: A Multicenter Prospective Randomized Controlled Analysis in China

“…Previous studies in mixed patient cohorts or non-randomized studies have suggested that early ART treatment could decrease mortality and possibly improve clinical outcomes (1,3). However, a systematic review which included subjects from the United States, South Africa, Zimbabwe, and Puerto Rico found insufficient evidence to support either early or deferred initiation of ART (14). In another large Latin-American cohort study, there also appeared to be no statistically significant difference in the probability of survival between patients who started ART within 2 weeks of CM vs. those initiating ART between 2 and 8 weeks after CM diagnosis (15).…”

Immediate versus deferred antiretroviral therapy in HIV-infected patients presenting with acute AIDS-defining events (toxoplasmosis, Pneumocystis jirovecii-pneumonia): a prospective, randomized, open-label multicenter study (IDEAL-study)

“…Other trials with different study populations, mostly in resource poor countries and with different OI (like tuberculosis, cryptococcal meningitis) showed worse outcomes, if ART was initiated sooner, compared to deferred initiation [26, 28, 29].…”

Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas

“…In our analysis, dynamic marginal structural models did not show an increased risk of death for patients who started ART within 2 weeks after diagnosis of cryptococcal meningitis compared with those who started during weeks 2–8. Our results are consistent with a systematic review that found no difference in mortality for early versus delayed ART initiation; this review included patients in Puerto Rico, Zimbabwe, the U.S., and South Africa 14 . However, this differs from the findings of the COAT trial, which found that patients randomized to start ART within 2 weeks after diagnosis of CM had a higher risk of mortality compared to those assigned to defer ART until 5 weeks after diagnosis of CM 9 .…”

The Effect of Early vs. Deferred Antiretroviral Therapy Initiation in HIV-Infected Patients With Cryptococcal Meningitis: A Multicenter Prospective Randomized Controlled Analysis in China

“…Previous studies in mixed patient cohorts or non-randomized studies have suggested that early ART treatment could decrease mortality and possibly improve clinical outcomes (1,3). However, a systematic review which included subjects from the United States, South Africa, Zimbabwe, and Puerto Rico found insufficient evidence to support either early or deferred initiation of ART (14). In another large Latin-American cohort study, there also appeared to be no statistically significant difference in the probability of survival between patients who started ART within 2 weeks of CM vs. those initiating ART between 2 and 8 weeks after CM diagnosis (15).…”

Immediate versus deferred antiretroviral therapy in HIV-infected patients presenting with acute AIDS-defining events (toxoplasmosis, Pneumocystis jirovecii-pneumonia): a prospective, randomized, open-label multicenter study (IDEAL-study)

“…Other trials with different study populations, mostly in resource poor countries and with different OI (like tuberculosis, cryptococcal meningitis) showed worse outcomes, if ART was initiated sooner, compared to deferred initiation [26, 28, 29].…”