Optimal Timing of Antiretroviral Therapy Initiation for HIV-Infected Adults With Newly Diagnosed Pulmonary Tuberculosis: A Systematic Review and Meta-analysis

Early ART initiation (1-4 weeks after start of TB treatment) reduced mortality vs. delayed initiation (after 8-12 weeks) in those with baseline CD4+ <0.05×109 cells/L, but was associated with a higher incidence of the TB-associated immune reconstitution inflammatory syndrome.

Guidance from the British HIV Association recommends the following with regards to initiation of antiretroviral therapy (ART) during TB therapy, for those with HIV and TB co-infection (Section 2.1.6):

 

• For those with CD4 count <100 cells/mL, start ART as soon as practical within 2 weeks after starting TB therapy
• For those with CD4 count 100–350 cells/mL, start ART as soon as practical, but it can wait until after completing 2 months’ TB treatment, especially when there are difficulties with drug interactions, adherence and toxicities
• For those with CD4 count >350 cells/mL, start ART at physician’s discretion