Data continue to emerge that suggest treating HIV infection as early as possible is beneficial. In this trial assessing the timing of antiretroviral therapy initiation in patients with acute cryptococcal meningitis and newly diagnosed HIV infection, early initiation was associated with increased mortality. Cryptococcus neoformans is the most common cause of meningitis in adults in sub-Saharan Africa, 1 – 5 and meningitis caused by C. neoformans accounts for approximately 20 to 25% of deaths from the acquired immunodeficiency syndrome (AIDS) in Africa. 6 – 9 Determining when antiretroviral therapy (ART) should be initiated after a diagnosis of cryptococcal meningitis involves balancing the survival benefit conferred by ART against the risk of the immune reconstitution inflammatory syndrome (IRIS), a paradoxical reaction that occurs during immunologic recovery with ART despite effective therapy for the opportunistic infection. Since 2009, the international standard of care has shifted toward earlier ART . . .