When to Start ART in HIV-Infected Adults with Newly Diagnosed Pulmonary TB?

Early ART improves survival in patients with CD4 counts <50 cells/mm³ but doubles risk for TB-associated immune reconstitution inflammatory syndrome; later initiation is possible for patients with higher counts.

Despite recent clinical trials, the best time to initiate antiretroviral therapy (ART) in many HIV-infected patients with newly diagnosed pulmonary tuberculosis (TB) remains uncertain. WHO guidelines recommend that TB treatment generally be started first, followed by ART within 8 weeks; for patients with CD4 counts <50 cells/mm³, however, ART should be started within 2 weeks after initiating TB treatment.

Now, investigators have conducted a meta-analysis to inform this issue. They searched several databases to find randomized, controlled trials comparing early and deferred ART initiation (2–4 weeks vs. 8–12 weeks after starting TB treatment), published between January 1980 and May 2015. Eight trials conducted in sub-Saharan Africa, Asia, and…

Reviewing Author

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

When to Start ART in HIV-Infected Adults with Newly Diagnosed Pulmonary TB?

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Reviewing Author