Acquired immunodeficiency syndrome
ICD-10 B20; B24 · ICD-11 1C62.3

Treatment of AIDS in Active Tuberculosis Without Tuberculous Meningitis

Managing HIV/AIDS alongside active tuberculosis requires coordinating two concurrent treatment courses. When tuberculous meningitis has been excluded, specific guidance governs when antiretroviral therapy should start and how the tuberculosis regimen shapes the choice of antiretrovirals.

Clinical Scenario

The patient has Acquired immunodeficiency syndrome with confirmed active tuberculosis. Tuberculous meningitis is absent. The clinical challenge is integrating antiretroviral therapy with an ongoing tuberculosis treatment course while managing interactions between the two regimens.

Treatment Approach — Partial Overview

Current evidence supports initiating antiretroviral therapy early after tuberculosis treatment has started. The specific antiretroviral combination selected depends on whether the tuberculosis regimen includes a rifamycin — this interaction directly determines which antiretroviral agents are appropriate. The complete regimen, timing criteria, and alternative options are detailed in the full protocol…

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1001/jama.2024.24543

For people with HIV and active tuberculosis excluding tuberculous meningitis, ART initiation is recommended within 2 weeks after starting treatment for tuberculosis, particularly if the CD4+ cell count is below 50/μL (evidence rating: AIa).

For active tuberculosis, persons with HIV being treated with a rifamycin-containing regimen should receive dolutegravir at a dosage of 50 mg twice daily (evidence rating: AIa) until longer-term follow-up data from studies evaluating once-daily dolutegravir in this setting become available.

Dolutegravir (50 mg twice daily) (evidence rating: AIa) during treatment for active tuberculosis with a rifamycin-containing regimen.

Efavirenz (600 mg) (evidence rating: AIa).

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