Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial

The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis

“…We excluded seven papers [5], [6], [7], [8], [9], [43], [44] reporting results from large trials that focused on time of ART initiation during TB treatment as TB mortality data was only reported at time points that lay beyond our pre-specified ‘during treatment’ period [6], [7], [43], [44], the outcome was death combined with AIDS-defining illness and mortality data could not be extrapolated [7] or focused only on tuberculous meningitis [9]. Study enrollment periods ranged from 4 months [30] to 8 years [40].…”

“…The question of when to start ART in HIV-positive TB patients has been addressed by the above-cited RCTs [5], [6], [7], [8], [50] and - based on their findings - HIV and TB guidelines recommend that among HIV-positive TB patients with CD4 less than 50 cells/mm 3 , ART should be initiated within 2 weeks from TB treatment start and if CD4 above 50 cell/mm 3 , within 8 weeks [51], [52], [53], [54], [55]. Nonetheless, the issue remains controversial as results from a recent trial reported no difference in mortality between early and delayed ART for HIV-positive TB patients with CD4 counts of 220 cells/mm 3 or more with authors arguing WHO guidelines should be updated accordingly [44] while, on the other hand, some researchers question the need of investing resources in other randomized, controlled trials on the same topic [56].…”

Outcomes from the implementation of a counselling model supporting rapid antiretroviral treatment initiation in a primary healthcare clinic in Khayelitsha, South Africa

“…In addition to counselling model research, more studies are required that report on the extent of delays and losses to care attributable to lengthy ART preparation processes prior to ART initiation. Lastly, whilst there is substantial evidence on optimal timing for starting ART after TB treatment initiation from a clinical perspective, 32,33 competing risk analysis would benefit from studies reporting on losses to care caused by delaying ART initiation for TB co-infected patients.…”

Disseminated tuberculous lymphadenitis presenting as cervical mass in patient with HIV infection, worsening after antiretroviral initiation: diagnosis and treatment challenges

“…All these studies concluded that starting HIV treatment soon after TB treatment improves outcomes 13. Contrary to these trials, a recent study (TB-highly active antiretroviral therapy) done in countries in the southern part of Africa on patients with confirmed TB, suggested that if CD4 count >220 cells/mL, ART can be delayed until 6 months of TB treatment 14. Currently, after reviewing these studies, a CDC expert panel recommendation is to start ART within 2 weeks of TB treatment initiation for ART-naive patients with CD4 counts <50 cells/mL and within 8 weeks for those with higher CD4 counts 15.…”