- For patients with active TB among whom ART is indicated, the first priority is to initiate TB treatment in accordance with NTP guidelines. Management of patients with TB/HIV co-infection should be performed in consultation with a TB-HIV expert.
- Case-fatality rates in patients with TB during the first two months of TB treatment are high HIV prevalence settings. Nevertheless, ART can drastically reduce mortality among patients with TB/HIV, especially among those with low CD4 counts. People with CD4 counts below 50 cells/mm3 ART should be initiated within two weeks.(Ref).
- This recommendation does not hold true among HIV-positive patients with tuberculous meningitis because of its association with higher rate of adverse events compared with initiation of ART two months after start of anti-TB treatment.
- There are potential reasons to consider later initiation of ART including high pill burden, drug-drug interactions, toxicity and immune reconstitution inflammatory syndrome (IRIS).
- However, for patients (adults and children) whose CD4 counts are above 50 cells/mm3, including those with drug-resistant TB, ART should be initiated within 8 weeks of initiation of anti-TB treatment.
Here is a table summarizing the current recommendations.
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