Question

A recently diagnosed HIV-positive patient with a CD4 count of 250 cells/mm\(^3\) also tests positive for active tuberculosis. He has not yet been started on ART. What is the correct approach to initiating treatment?

• A. Start ATT first, then initiate ART after 2 weeks
• B. Start ART first, then begin ATT after 2 weeks
• C. Start both ART and ATT simultaneously
• D. Start ATT first, then initiate ART after 8 weeks

Hint:

In HIV with active TB, start ATT first; then start ART early, especially when CD4 count is low.

Answer 1

The Correct Option is A

Concept: In HIV-TB coinfection, antitubercular therapy is usually started first. ART is started soon after, depending on CD4 count and clinical status, to reduce mortality while limiting complications like IRIS.

Step 1: Identify coinfection.
The patient has: \[ \text{HIV + active tuberculosis} \]

Step 2: Start tuberculosis treatment first.
Active TB should be treated immediately with ATT.

Step 3: Start ART soon after.
With CD4 count of 250 cells/mm\(^3\), ART is initiated after starting ATT, here after 2 weeks.