More on When to Start Antiretroviral Therapy in the Setting of Tuberculosis Treatment

Current WHO guidelines recommend initiation of antiretroviral therapy (ART) in all HIV-infected patients with active tuberculosis (TB), regardless of CD4-cell count, to delay progression of their HIV infection. In this study, investigators examined whether concurrent ART improves response to TB therapy in patients with high CD4-cell counts. They also assessed the significance of having sputum smears positive for acid-fast bacilli (AFB) after 5 months of TB therapy — a situation that, in the absence of sputum culture results, would qualify as TB-treatment failure, according to WHO guidelines.

A total of 223 HIV-infected patients in Uganda who had CD4 counts >350 cells/mm³ and active pulmonary TB were randomized to receive TB therapy alone (as…