Initiating anti-retroviral (ART) treatment within two weeks of the diagnosis of tuberculosis increases life expectancy among patients with both the infections who have very low immunity, says a new research.
However, patients with stronger immune system might benefit from waiting until the end of six month TB treatment before initiating ART therapy said researchers.
"Infection with HIV can promote progression and re-infection to active TB after initial exposure to Mycobacterium tuberculosis, the organism that causes TB," said senior author Jean B Nachega, associate professor at University of Pittsburgh Graduate School Of Public Health.
Treating HIV and TB simultaneously is challenging as the patients should take multiple pills a day, drug interactions and side effects.
"Current World Health Organization guidelines recommend starting TB treatment first, followed by HIV treatment as soon as possible within two to eight weeks for patients who have moderately to severely compromised immune systems, but there was not conclusive evidence to guide treatment in other levels of immune suppression," said Nachega.
The researchers aimed to investigate the optimal timing of HIV initiation in light of recent published randomized clinical trials on the topic said Nachega.
The researchers reviewed data from more than 4,500 people participating in eight randomized clinical trials of early initiation of ART conducted in Asia, Africa and the US.
The researchers found that survival rates were better among patients who started ART within two weeks of diagnosis of TB and who also had CD4 T-cell counts of less than 0.050 x 109 cells per liter.
"Our findings support guidelines recommending early initiation of ART in patients with a high degree of immune system compromise. But delaying ART might be possible until the end of TB treatment with patients with CD4 counts greater than 0.220 x 109 cells per liter, which could reduce the burden of taking two complex drug regimens at the same time," Nachega said.
The study was published in the journal Annals of Internal Medicine.