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ART Timing with OI — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesART Timing with OIRACP Adult Medicine

A 25-year-old man newly diagnosed with HIV has a CD4 of 45 cells/μL and an opportunistic infection (PJP). He is started on TMP-SMX for PJP. Regarding ART initiation timing, when should ART be started?

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Correct answer: B — Within 2 weeks of OI treatment

For most opportunistic infections (including PJP), ART should be started within 2 weeks of commencing OI treatment to reduce mortality. The exception is cryptococcal meningitis, where ART should be deferred for 4–6 weeks (early ART increases mortality from IRIS). TB-HIV coinfection: ART within 2 weeks if CD4 <50, within 8 weeks if CD4 >50.

Reference: ASHM – 2024 – HIV Guidelines; WHO 2024; ACTG A5164 Trial