Which to Treat First: HIV or an OI?

Should treatment-naive HIVers start anti-HIV therapy if they're being concurrently treated for an acute opportunistic infection? Unfortunately, no one has a clear answer. Some doctors are reluctant to simultaneously treat both conditions due to concerns about drug interactions, additional medication side effects, and the development of immune reconstitution inflammatory syndrome -- essentially a flare-up of the OI as the body's immune system strengthens. And U.S. and international treatment guidelines are ambiguous on the subject, stating HIV treatment may be considered but offering no firm recommendations. But new research published in the journal PLoS One shows that concurrent treatment may be the best option. A yearlong study of nearly 300 treatment-naive HIVers diagnosed with an OI showed that those who began antiretroviral medications earlier had a lower risk of death than those delaying treatment. Among the participants who began anti-HIV therapy promptly, 14% died or developed another OI, compared to 24% of those who delayed anti-HIV drugs for an average of 45 days. Better overall HIV suppression was also achieved by more of the HIVers who started antiretroviral therapy early. The researchers conclude that the notion of first treating the acute OI infection and delaying anti-HIV therapy is wrong. "The study shows very clearly there is no safety downside to [concurrent therapy] -- and the benefit is quite substantial, reducing death by 50%," said lead researcher Andrew Zolopa of Stanford University.