Optimal Time to Start Antiretroviral Therapy in HIV-infected Adults With Cryptococcal Meningitis

Inclusion Criteria: * HIV 1 infection confirmed by licensed ELISA kit and/or detectable Viral load. * Confirmed Cryptococcal meningitis on the current admission by India ink or CSF cryptococcal antigen * ART naive at the time of enrollment * 21 years old and above * Ability and willingness to give written informed consent to participate in the study * Able (as assessed by the patient's medical team)to initiate amphotericin B for cryptococcal meningitis * Initiated amphotericin B 72 hours or less prior to assessment for enrollment or not on amphotericin B at the time of assessment for enrollment * Agrees to obtain outpatient care after discharge within 50 kilometers from Princess Marina Hospital,Scottish Livingstone Hospital and Bamalete Lutheran Hospital Exclusion Criteria: * Recent (within the past 4 weeks) antifungal use * Pregnant or breastfeeding * Initiated anti-tubercular therapy 2 weeks or less prior to assessment for enrollment. * Bacterial meningitis at the time of assessment for enrollment. * Recent (within the past 1 month) use of the following:systemic cancer chemotherapy,oral or intravenous corticosteroids or other immunomodulators. * Judged by study coordinator to be likely to initiate chemotherapy or any other immunomodulatory therapy prior to the 4 week LP. * Imprisoned.