HIV/TB Coinfection + Low CD4-Cell Count = Start ART Sooner Rather Than Later

The results of three randomized, controlled trials (SAPiT, STRIDE, and CAMELIA) demonstrate that, for coinfected patients with advanced immunosuppression, the survival benefit of starting ART within the first 2 weeks of TB therapy outweighs the risk for immune reconstitution inflammatory syndrome and other adverse events.

Although tuberculosis (TB) is the most common AIDS-defining opportunistic infection worldwide, the timing of antiretroviral therapy (ART) in HIV/TB-coinfected patients has not been well established. Until recently, many clinicians would defer ART until the completion of TB therapy because of concerns about drug interactions, a high pill burden, and the development of immune reconstitution inflammatory syndrome (IRIS). 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). Based on these findings, the WHO treatment guidelines currently recommend starting ART as soon as possible after the initiation of…

Reviewing Author

Carlos del Rio, MD

HIV/TB Coinfection + Low CD4-Cell Count = Start ART Sooner Rather Than Later

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Reviewing Author