Timing of ARV Initiation i/s/o OIs

Question 1

PCP

Answer 1

Start ARVs within 2 weeks; better outcomes than dealying.

Question 2

Toxo

Answer 2

within 2-3 weeks

Question 3

Disseminated MAC disease

Answer 3

Start ARVs right away

Question 4

Cryptococcal meningitits

Answer 4

at least 2 weeks (induction phase) up to 10 weeks (induction + consolidation phase)

Question 5

CMV retinitis (or neurologic disease)

Answer 5

start CMV tx and then start ARVs 2 weeks later

Question 6

PML: causative virus? timing of ARV initiation if PML is presenting HIV sign

Answer 6

JC Virus; start immediately

Question 7

candida esophagitis

Answer 7

start right away

Question 8

histoplasmosis

Answer 8

as soon as possible after starting anti-fungals

Question 9

bartonella

Answer 9

For most persons with HIV and Bartonella infection, antiretroviral therapy does not need to be delayed. If, however, the individual is diagnosed with ophthalmic Bartonella infection, then antiretroviral therapy should be delayed until they have completed a 2 to 4 week treatment course with doxycycline plus rifampin

Question 10

coccidioidomycosis

Answer 10

consult an expert if meningitis

Question 11

cryptosporidiosis

Answer 11

ARVs are the mainstay of tx: start right away

Question 12

microsporidiosis

Answer 12

ARV therapy is the mainstay of tx for persons with HIV and microsporidiosis and should be initiated immediately

Question 13

Cystoisosporiasis

Answer 13

Limited data exist regarding the timing of initiating antiretroviral therapy in patients with acute cystoisosporiasis. Nevertheless, the Adult and Adolescent Opportunistic Infection Guidelines recommend starting antiretroviral therapy at the time treatment for cystoisosporiasis is started, unless there is concern that the antiretroviral therapy medications will not be absorbed well.