علاج الإيدز مع التهاب السحايا بالمستخفيات أو مستضدية المستخفيات اللاعرضية

References

DOI: 10.1001/jama.2024.24543

For persons with cryptococcal meningitis who can be closely monitored and treated for increased intracranial pressure and immune reconstitution inflammatory syndrome, ART initiation is recommended within 2 to 4 weeks after starting antifungal therapy, with earlier initiation at 2 weeks after starting antifungal therapy for those who have clinically improved, have control of intracranial pressure, have negative CSF cultures with use of antifungal therapy, and can continue to be closely monitored; those who do not meet these criteria should initiate ART 4 weeks after starting antifungal therapy (evidence rating: BIII).

For ART-naive individuals with asymptomatic cryptococcal antigenemia and a negative lumbar puncture, immediate ART and preemptive fluconazole are recommended (evidence rating: BIII).

All patients should be closely monitored and treated for increased intracranial pressure.