Clarity on When to Start ART in Active TB

For HIV/TB-coinfected patients with advanced immunosuppression, the survival benefit of starting ART within the first 2 weeks after initiation of TB therapy outweighs the risks for IRIS and other adverse events.

Three recent randomized, controlled trials finally brought clarity to the issue of when to start antiretroviral therapy (ART) in HIV-infected patients with tuberculosis (TB). In 2010, the initial results of the SAPiT trial showed a substantial mortality benefit from starting ART during the first 3 months of TB treatment rather than later (JW AIDS Clin Care Feb 24 2010). In 2011, the final results of SAPiT, STRIDE, and CAMELIA revealed that the optimal timing of early ART initiation in HIV/TB-coinfected patients depends on baseline CD4-cell count (JW AIDS Clin Care Oct 19 2011).

Although the three studies had slightly different designs and study populations, all confirmed that when HIV/TB-coinfected patients have CD4 counts <50 cells/mm³, the…

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Carlos del Rio, MD

Clarity on When to Start ART in Active TB

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