Faculty Sponsor

Jana Stedman

College

College of Nursing & Health Professions (CONHP)

Department/Program

Physician Assistant Program

Presentation Type

Poster Presentation

Symposium Date

Summer 7-23-2025

Abstract

Objective: To evaluate the optimal timing of antiretroviral therapy (ART) initiation in HIV-1-infected adults with bacterial or fungal opportunistic infections (OIs), and to assess its impact on immune reconstitution inflammatory syndrome (IRIS), mortality, and pathogen type.

Methods: A structured literature review was conducted using PubMed, IDSA guidelines, and supplemental Google searches. Search terms included combinations such as "ART initiation TB meningitis," "ART initiation IRIS TB," "ART intiation IRIS cryptococcal," and "ART initiation IRIS pneumocystis." Studies published in English from 2019-2024 were included, with one exception for TB meningitis due to limited recent data. Eligible studies were randomized controlled trials or systematic reviews comparing early (<2 weeks) vs. delayed (>2 weeks) ART initiation in ART-naive HIV-1-infected adults with bacterial (tuberculosis [TB], TB meningitis) or fungal (cryptococcal meningitis [CM], Pneumocystis pneumonia [PCP]) OIs. Outcomes included IRIS incidence and mortality.

Results: In TB, early ART showed the greatest mortality benefit in patients with CD4 <50, despite increased non-fatal IRIS. For TB meningitis, delayed ART was preferred due to increased severe adverse events and no survival benefit with early ART. Early ART was advised for PCP due to high mortality and no effect on IRIS. In CM, delayed ART reduced mortality in low-income settings, while early ART appeared safe in high-income settings. Pathogen type did not independently predict IRIS.

Conclusion: Current ART timing guidelines remain appropriate. However, early ART in CM may be safe in high-income settings. IRIS warrants continued attention and improved diagnostic criteria.

Keywords: HIV; antiretroviral therapy; IRIS; opportunistic infections; tuberculosis; cryptococcal meningitis

Biographical Information about Author(s)

I became interested in HIV and ART timing initiation when I encountered HIV patients recovering from opportunistic infections in my infectious disease clinical rotation. That is where I was introduced to the concept of immune reconstitution inflammatory syndrome (IRIS) and how it can affect management of care in this patient population. I plan to further pursue my interests in infectious disease and internal medicine as future career opportunities.

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