Starting ARVs in the setting of
Opportunistic Infections
2
Learning Objectives
At the end of this presentation, the participant should be able
to:
•Cite 3 opportunistic infections where ARV therapy is part of
the treatment
•Cite 5 opportunistic infections where ARV initiation may
lead to IRS
•Give the appropriate management for a newly diagnosed
PLWHA on TB therapy who has a CD4 count < 200.
•Give the dose of EFV that should be used when treating TB
in Vietnam.
•Cite the recommendation of the MOH of the use of NVP
with a RIF containing TB therapy
•Cite the best time and clinical conditions that a patient with
a treated OI can be started on ARV therapy
3
Outline of Presentation
•Introduction
•In which OIs can you start ARVs right away and
in which can you not?
Tuberculosis – What therapy can we start?
•Tuberculosis – When can we start therapy?
•Tuberculosis – Four treatment scenarios.
•Cryptococcus – When can we start therapy?
•Side Effects of ARV and OI medications
Starting ARVs in the setting of an active
Opportunistic Infection
Introduction
5
Introduction
•The decision to start ARVs is a balance
between
–wanting the immune system to recover in order to
fight infection
vs.
–the risk of drug interactions and side effects
–the risk of immune reconstitution syndrome