Question:
A patient is diagnosed with HIV and tuberculosis together. How should anti-tubercular treatment (ATT) and combination antiretroviral therapy (cART) be started?
A patient is diagnosed with HIV and tuberculosis together. How should anti-tubercular treatment (ATT) and combination antiretroviral therapy (cART) be started?
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Control the mycobacteria before reviving the immune system to avoid IRIS.
Updated On: Jun 24, 2026
- Start ATT first
- Start cART first
- Start both simultaneously
- Start cART only
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The Correct Option is A
Solution and Explanation
Step 1: When HIV and active tuberculosis are diagnosed at the same time, anti-tubercular treatment (ATT) is started first, and antiretroviral therapy is added a little later.
Step 2: The reason is to reduce the risk of Immune Reconstitution Inflammatory Syndrome (IRIS). If cART is begun first, the recovering CD4 count mounts an exaggerated inflammatory response against the existing TB infection, paradoxically worsening symptoms.
Step 3: Starting ATT roughly 2 weeks before cART has been shown to lower the incidence of IRIS while still controlling the mycobacterial load. cART is not delayed indefinitely; it is initiated within the first few weeks based on the CD4 count.
Step 4: Therefore the correct sequence is to start ATT first.
Step 2: The reason is to reduce the risk of Immune Reconstitution Inflammatory Syndrome (IRIS). If cART is begun first, the recovering CD4 count mounts an exaggerated inflammatory response against the existing TB infection, paradoxically worsening symptoms.
Step 3: Starting ATT roughly 2 weeks before cART has been shown to lower the incidence of IRIS while still controlling the mycobacterial load. cART is not delayed indefinitely; it is initiated within the first few weeks based on the CD4 count.
Step 4: Therefore the correct sequence is to start ATT first.
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