Case 4. Under Pressure: Cryptococcus, ART Initiation, and the Threat of IRIS

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Viremic – Cases in HIV

Dr. Eileen Scully & Dr. Christopher Hoffmann

4 episodes

2 days ago

Hosted by Eileen Scully, MD, PhD, and Christopher Hoffmann, MD, MSC, MPH, both HIV specialists at Johns Hopkins, Viremic explores quandaries in adult HIV care. Each case discussion includes medical history and diagnoses, challenges in care and treatment, and key evidence and guidelines that informed clinical decision‑making. All clinical discussions presented on Viremic are for informational purposes only and are not offered as medical or clinical practice advice for patients or clinicians. Viremic is produced by the Clinical Guidelines Program, a collaborative effort of the New York State Department of Health AIDS Institute and the Johns Hopkins University Division of Infectious Diseases.

All content for Viremic – Cases in HIV is the property of Dr. Eileen Scully & Dr. Christopher Hoffmann and is served directly from their servers with no modification, redirects, or rehosting. The podcast is not affiliated with or endorsed by Podjoint in any way.

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Case 4. Under Pressure: Cryptococcus, ART Initiation, and the Threat of IRIS

Viremic – Cases in HIV

40 minutes

2 days ago

Case 4. Under Pressure: Cryptococcus, ART Initiation, and the Threat of IRIS

After brief mention of an HIV vaccine, the hosts turn to the challenges of treating cryptococcal meningitis in a 46-year-old woman with profound immune suppression after being off ART for 6-12 months. Emphasizing the high potential for morbidity and mortality, Chris and Eileen focus on the complexities of cryptococcal meningitis medical management, including the role of immune constitution, timing of ART initiation, and the risk of IRIS. Listen as they work through the treatment requirements and clinical decisions involved in this complicated case.

References Cited

Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med. 2014;370(26):2487-2498. PMID: 24963568
Chang CC, Dorasamy AA, Gosnell BI, et al. Clinical and mycological predictors of cryptococcosis-associated immune reconstitution inflammatory syndrome. AIDS. 2013;27(13):2089-2099. PMID: 23525034
Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2025;333(7):609-628. PMID: 39616604
Ingle SM, Miro JM, May MT, et al. 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. Clin Infect Dis. 2023;77(1):64-73. PMID: 36883578
Kwizera R, Kiiza TK, Akampurira A, Kimuda S, Mugabi T, Meya DB. Evolution of Laboratory Diagnostics for Cryptococcosis and Missing Links to Optimize Diagnosis and Outcomes in Resource-Constrained Settings. Open Forum Infect Dis. 2024;11(9):ofae487. Published 2024 Aug 27. PMID: 3928635
Makadzange AT, Ndhlovu CE, Takarinda K, Reid M, Kurangwa M, Gona P, Hakim JG. Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in sub-saharan Africa. Clin Infect Dis. 2010 Jun 1;50(11):1532-8. PMID: 20415574.
Srichatrapimuk S, Sungkanuparph S. Integrated therapy for HIV and cryptococcosis. AIDS Res Ther. 2016;13(1):42. Published 2016 Nov 29. PMID: 27906037

Related Guidelines

Clinical info HIV.gov: Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV: Cryptococcosis
IAS-USA: Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel
NYSDOH AI Clinical Guidelines Program: Management of IRIS