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Opportunistic Infections 

Opportunistic Infections
Chapter:
Opportunistic Infections
Author(s):

Ben J. Barnett

, Lisa Armitige

, and Karen J. Vigil

DOI:
10.1093/med/9780190493097.003.0032
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date: 08 December 2019

The question of when to initiate antiretroviral therapy (ART) in the setting of an acute or ongoing opportunistic infection (OI) has been controversial. The immediate initiation of ART in the presence of an OI may provide better clinical outcomes as the immune system improves. However, rapidly decreasing HIV viral load has been associated with the immune reconstitution inflammatory syndrome, which may lead to further complications in the setting of an OI. There are also questions of increasing pill burden, potential drug–drug interactions, additive toxicity and adverse events, and the more practical problem of continuity of care if ART is started in a hospital setting for a newly diagnosed patient with HIV without established outpatient care already in place. This problem could be particularly troublesome for patients who do not have health insurance or otherwise do not have affordable access to ART in the outpatient setting.

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