ART timing in HIV-TB — DTM&H MCQ

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ModerateHIV in TropicsART timing in HIV-TBDTM&H

A 36-year-old HIV-positive Rwandan man with CD4 90 has confirmed TB (GeneXpert positive, rifampicin-sensitive). When should ART be initiated?

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Correct answer: B — Within 2 weeks of starting TB treatment

With CD4 <50, ART within 2 weeks of TB treatment (CAMELIA, STRIDE, SAPiT trials). For CD4 >50, within 8 weeks. Early ART reduces mortality despite TB-IRIS risk. DTG dose adjustment: 50 mg twice daily during rifampicin co-administration.

Reference: WHO HIV-TB Guidelines; SAPiT, CAMELIA, STRIDE trials