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Testicular Cancer Incidental — SCE Infectious Diseases MCQ

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HardSTIsTesticular Cancer IncidentalSCE Infectious Diseases

A newly diagnosed patient with HIV has cryptococcal meningitis, high CSF fungal burden and raised opening pressure. Antifungal induction and therapeutic lumbar punctures have begun today. When should ART be started?

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Correct answer: C — Begin ART about 4–6 weeks after antifungal treatment starts, once intracranial pressure and the clinical course are controlled

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

D is correct. Cryptococcal meningitis is a major exception to same-day or routine rapid ART: early immune recovery while fungal burden and intracranial inflammation remain high increases neurological IRIS and mortality. ART is generally started about four to six weeks after antifungal treatment begins, individualised to induction response and intracranial-pressure control. A, B and C are progressively early schedules that remain unsafe in this high-burden presentation; corticosteroid prophylaxis does not make day-7 ART safe. E delays ART beyond the usual window and prolongs uncontrolled HIV. Antifungal optimisation and therapeutic lumbar punctures continue throughout the timing decision.

Reference: BHIVA: antiretroviral treatment guideline 2025 interim update: https://bhiva.org/clinical-guideline/hiv-1-treatment-guidelines/