Balancing the Risks and Benefits of Early ART Initiation in HIV-Infected Patients with TB

Previous reports from the SAPiT trial have shown that HIV-infected patients with tuberculosis (TB), particularly those with CD4 counts <50 cells/mm³, can improve their chances of survival by initiating antiretroviral therapy (ART) shortly after starting TB treatment (JW AIDS Clin Care Oct 19 2011). However, this survival benefit of early ART is offset by an increased risk for immune reconstitution inflammatory syndrome (IRIS). In a new report from the SAPiT trial, investigators provide additional detail about this risk.

A total of 642 HIV-infected patients with baseline CD4 counts <500 cells/mm³ and sputum smear-positive TB were randomized to one of three treatment groups:

• Early integrated therapy: ART was started within 4 weeks after TB trea…