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Timing of ART in patients coinfected with HIV, TB

KEY POINT

Three recently published studies showed that in patients with HIV and newly diagnosed tuberculosis (TB) who had CD4 cell counts below 200 cells/mm3, early initiation of antiretroviral therapy (ART) increased survival. The risk of developing TB-associated immune reconstitution inflammatory syndrome (IRIS) increased with early ART, making the benefits of early therapy less clear in those with higher CD4 counts.

SOURCES

Blanc FX et al. Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis. N Engl J Med. 2011;365:1471–81.

Havlir DV et al. Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011;365:1482–91.

Abdool Karim SS et al. Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med. 2011;365:1492–501.

Török ME, Farrar JJ. When to start antiretroviral therapy in HIV-associated tuberculosis [editorial]. N Engl J Med. 2011;365:1538–40.