ART in the Setting of TB Treatment: Earlier Is Better

Two major trials this year confirmed the benefits of initiating antiretroviral therapy (ART) early among HIV-infected patients receiving treatment for active tuberculosis (TB). The findings alleviated long-held concerns about complex drug interactions between ART and TB medications and about morbidity associated with immune reconstitution inflammatory syndrome (IRIS).

In the SAPiT trial, coinfected adults with CD4 counts <500 cells/mm³ were randomized to start ART within 4 weeks after starting TB treatment (early integrated therapy), within 4 weeks after completing the intensive four-drug phase of TB treatment (late integrated therapy), or after the completion of all TB treatment (sequential therapy). Mortality rates were found to be 56% low…