Timing of Initiation of First-line Antiretroviral Therapy

  • Authors: Marshall J. Glesby, MD, PhD; Timothy J. Wilkin, MD, MPH (More Info)
  • Section Editor: Joel E. Gallant, MD, MPH
  • Editors in Chief: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 4/1/16 (What's New)


  • In general, early initiation of ART is recommended after starting active treatment for opportunistic infections
  • Data suggest that ART may be deferred in patients with cryptococcal meningitis, in whom early ART has not been shown to reduce morbidity and mortality in low-income countries[Makadzange 2010; Boulware 2014]
    • WHO recommends ART initiation should be deferred until there is evidence of a sustained clinical response to antifungal therapy and after 2-4 weeks of induction and consolidation treatment with amphotericin B–containing regimens combined with flucytosine or fluconazole or after 4-6 weeks of treatment with a high-dose oral fluconazole induction and consolidation regimen (Management Guidelines)[WHO CM]

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