Initiating ART
- Clinicians should recommend that patients initiate ART within 2 weeks of beginning treatment for active OIs, with exceptions to this recommendation noted below. (A1)
- Clinicians should consult with a care provider experienced in managing HIV in patients with active OIs to determine when to initiate ART in patients with TB meningitis, extrapulmonary TB, CMV retinitis, or cryptococcal infection. (A3)
- For patients with CD4 counts <100 cells/mm3 or known concomitant OIs who are initiating ART, clinicians should be vigilant for the signs and symptoms of IRIS and should educate patients about the risk of developing IRIS. (A3)
- For patients with HIV who have HBV or HCV co-infection, clinicians should:
- Measure transaminase levels before initiation of ART, at 6 and 12 weeks after initiation, and at least every 6 months thereafter to monitor for possible IRIS. (A3)
- Refer patients with elevated transaminase levels in conjunction with jaundice, elevated bilirubin levels, or loss of synthetic function for evaluation by a hepatologist. (B3)
