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 (110) particularly in highly immunocompromised patients (CD4 cell count <50 cells/mm³) (111, 112). 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 the HIV-positive drug-susceptible TB patient. 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 (110, 113). However, for HIV-positive TB patients with profound immunosuppression (e.g. CD4 counts less than 50 cells/ mm³), they should receive ART within the first 2 weeks of initiating TB treatment (30).