{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:20:22Z","timestamp":1791933622736,"version":"4.3.4"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T00:00:00Z","timestamp":1678233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003323","name":"ANRS","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003323","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020421","name":"HIV Monitoring Foundation,","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100020421","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Randomized controlled trials (RCTs) from low- and middle-income settings suggested that early initiation of antiretroviral therapy (ART) leads to higher mortality rates among people with HIV (PWH) who present with cryptococcal meningitis (CM). There is limited information about the impact of ART timing on mortality rates in similar people in high-income settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data on ART-naive PWH with CM diagnosed from 1994 to 2012 from Europe\/North America were pooled from the COHERE, NA-ACCORD, and CNICS HIV cohort collaborations. Follow-up was considered to span from the date of CM diagnosis to earliest of the following: death, last follow-up, or 6 months. We used marginal structural models to mimic an RCT comparing the effects of early (within 14 days of CM) and late (14\u201356 days after CM) ART on all-cause mortality, adjusting for potential confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 190 participants identified, 33 (17%) died within 6 months. At CM diagnosis, their median age (interquartile range) was 38 (33\u201344) years; the median CD4+ T-cell count, 19\/\u03bcL (10\u201356\/\u03bcL); and median HIV viral load, 5.3 (4.9\u20135.6) log10 copies\/mL. Most participants (n = 157 [83%]) were male, and 145 (76%) started ART. Mimicking an RCT, with 190 people in each group, there were 13 deaths among participants with an early ART regimen and 20 deaths among those with a late ART regimen. The crude and adjusted hazard ratios comparing late with early ART were 1.28 (95% confidence interval, .64\u20132.56) and 1.40 (.66\u20132.95), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found little evidence that early ART was associated with higher mortality rates among PWH presenting with CM in high-income settings, although confidence intervals were wide.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad122","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T23:18:37Z","timestamp":1678144717000},"page":"64-73","source":"Crossref","is-referenced-by-count":20,"title":["Early Antiretroviral Therapy Not Associated With Higher Cryptococcal Meningitis Mortality in People With Human Immunodeficiency Virus in High-Income Countries: An International Collaborative Cohort Study"],"prefix":"10.1093","volume":"77","author":[{"given":"Suzanne M","family":"Ingle","sequence":"first","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol , Bristol ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M","family":"Miro","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service Hospital Clinic\u2013IDIBAPS, University of Barcelona , Barcelona ,","place":["Spain"]},{"name":"CIBERINFEC, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret T","family":"May","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol , Bristol ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E","family":"Cain","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. 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,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Cazanave","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, CHU de Bordeaux , Bordeaux ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Reiss","sequence":"additional","affiliation":[{"name":"Stichting HIV Monitoring , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Brandes","sequence":"additional","affiliation":[{"name":"Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne , Cologne ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiner C","family":"Bucher","sequence":"additional","affiliation":[{"name":"Basel Institute for Clinical Epidemiology & Biostatistics, Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel , Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Sabin","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc","family":"Vidal","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili , Tarragona ,","place":["Spain"]},{"name":"CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Obel","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet , Copenhagen 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