Treatment of Acquired Immunodeficiency Syndrome in Active Tuberculosis Without Tuberculous Meningitis

This protocol addresses antiretroviral therapy (ART) initiation in people with HIV/AIDS who have active tuberculosis, specifically when tuberculous meningitis is absent. The concurrent management of both infections requires careful coordination of timing and drug selection.

The defining features of this scenario are active tuberculosis and the confirmed absence of tuberculous meningitis. This distinction is clinically significant — it directly influences both the timing of ART initiation and which antituberculous agents are appropriate alongside antiretroviral drugs.

Management involves a ritonavir-boosted antiretroviral backbone combined with a specific substitution within the antituberculous regimen to address drug–drug interactions with rifamycins. The full regimen, including the complete drug selection criteria and sequencing, is detailed in the structured 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).

If none of these regimens can be used, ritonavir-boosted atazanavir or lopinavir with TXF/XTC may be used with rifabutin (150 mg daily) (evidence rating: AIII).

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