6.4 Benefits

The strong recommendation for the use of ART is based in part on indirect evidence from its use in any patient with active TB, which shows large beneficial effects and a very high mortality when ART is not employed (120) particularly in highly immunocompromised patients (CD4 cell count <50 cells/mm3) (121, 122). In the absence of other data specific to patients with DR-TB receiving second-line antituberculosis medication, the decision on when to start ART should be no different from the approach to a patient living with HIV with drug-susceptible TB. ART should thus be initiated regardless of CD4 cell count and as soon as antituberculosis treatment is tolerated, ideally as early as 2 weeks and no later than 8 weeks after initiation of antituberculosis treatment (120, 123). However, for TB patients living with HIV with profound immunosuppression (e.g. CD4 counts <50 cells/mm3), they should receive ART within the first 2 weeks of initiating TB treatment (96).

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