When to Start Antiretroviral Therapy in HIV-Associated Tuberculosis

Tuberculosis is the most common infectious cause of death in persons infected with the human immunodeficiency virus (HIV). However, many of the basic questions have remained unanswered, such as when to start antiretroviral therapy (ART) in HIV-infected patients who present with tuberculosis. The early initiation of ART, begun either simultaneously with or soon after the start of tuberculosis therapy, may be associated with clinical deterioration related to the immune reconstitution inflammatory syndrome (IRIS), with toxic effects of drugs, drug interactions, and a high pill burden (possibly compromising adherence to therapy). Conversely, a delay in initiating ART may result in AIDS-related . . .