Julio C. Zuniga-Moya (@julioczuniga1.bsky.social)

Antiretroviral Therapy Management in Cryptococcal Meningitis To the Editor—We appreciate the thoughtful comments raised by Dr. Patamatamkul and colleagues [1] regarding our study on the impact of antiretroviral therapy (ART) duration in ART-experienced people with human immunodeficiency virus (HIV) who present with cryptococcal meningitis (CM) [2]. Our primary analysis focused on examining mortality differences according to time on ART at presentation with CM. The finding that patients who initiated ART within 14 days before CM diagnosis had a 1.7-fold increased risk of 2-week mortality compared to ART-naïve individuals remained robust after adjustment for antifungal treatment, age, and sex, and was remarkably consistent with previous findings from the ASTRO-CM trial [3] and ACTA trial [4]. It is also in keeping with randomized controlled trial data showing that very early ART initiation in individuals with CM is associated with increased mortality [5], likely reflecting immunopathology due to ART-mediated immune restoration in the context of high fungal burden [6]. https://academic.oup.com/cid/article/81/4/e240/8172287?rss=1