Although mortality is high among patients infected with both tuberculosis (TB) and HIV, there is debate on the best moment to start antiretroviral treatment (ART) when patients are on TB therapy. A study recently published in the New England Journal of Medicine reports on a randomised controlled trial (RCT) conducted in Durban (1). Patients diagnosed with both TB and HIV were started on ART either during standard TB therapy (429 patients) or within four weeks after completion of this therapy (213 patients). The results showed that the death rate in the group receiving HIV and TB treatment at the same time was lower than that of the other group (5.4 versus 12.1 deaths per 100 person-years). Therefore, the safety monitoring committee recommended that of September 1, 2008 all patients in the RCT should receive HIV and TB treatment simultaneously. Since even participants with relatively high CD4-counts of 200-500 cells/mm3 benefited from simultaneous treatment, the investigators suggested that treatment guidelines should recommend integrated therapy for everyone with a CD4-count less than 500 cells/mm3. The recently published South African antiretroviral treatment guidelines 2010 still recommend initiating ART in TB/HIV co-infected patients with a CD4-count of less than 350 cells/mm3 (2).

Reference(s)

1. Abdool Karim SS, Naidoo K, Grobler A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med. 2010;362(8):697-706. Link to abstract
2. SA Dept of Health. The South African Antiretroviral Treatment Guidelines, 2010. http://www.sanac.org.za/resources/art-guidelines Accessed May 14, 2010.