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Randomised controlled trial
Delaying initiation of ART for 5 weeks improves survival in patients with HIV infection with cyrptococcal meningitis
  1. A Tariro Makadzange1,
  2. Nomvuyo Mothobi2
  1. 1Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
  2. 2Department of Medicine, Parirenyatwa Hospital, Harare, Zimbabwe
  1. Correspondence to: Dr A Tariro Makadzange, Ragon Institute of MGH, MIT and Harvard, 400 Technology Square, Cambridge, MA 02139, USA; amakadzange{at}partners.org

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Context

Cryptococcal meningitis (CM) is a major cause of mortality for individuals with HIV infection in Africa. Early initiation of antiretroviral therapy (ART) has been shown to decrease mortality in a number of opportunistic infections such as tuberculosis (TB) and Pneumocystis jirovicii pneumonia, but may increase mortality in central nervous system-related opportunistic infections such as TB meningitis.1 The timing of ART however remains controversial for CM.2 ,3

Methods

The study by Bouleware and colleagues is a randomised trial that assigned 177 HIV-infected ART-naïve patients from Uganda and South Africa who were recently diagnosed with CM (median of 7–8 days) to either receive ART within 48 h of randomisation (early …

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