In HIV patients with invasive fungal disease should antiretroviral treatment be started later or earlier, and what is the risk for IRIS?

The bottom line: In spite of increased risk for developing IRIS with early initiation of antiretroviral therapy, especially with CD4 cell counts <50 cells/μL, ART should commence within 2 weeks after starting TB treatment in order to reduce mortality.

Huis In 't Veld The immune reconstitution inflammatory syndrome related to HIV co-infections: a review. Source: European journal of clinical microbiology & infectious diseases 2011

Summary: IRIS is a result of excessive pathogenspecific immune recovery reaction and occurs in patients on antiretroviral therapy. The most crucial risk factors for IRIS are a low CD4+ T-cell count and a brief time between treatment of the infection and onset of ART. The general approach to treatment of IRIS is to continue antiretroviral therapy and provide antimicrobial therapy for the provoking infection.

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