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Clinical and Developmental Immunology
Volume 2011, Article ID 103917, 10 pages
Review Article

Timing of Antiretroviral Therapy for HIV in the Setting of TB Treatment

1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 1550 Orleans Street, Rm 110, Baltimore, MD 21231, USA
2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA

Received 27 July 2010; Revised 6 October 2010; Accepted 20 October 2010

Academic Editor: Estee Torok

Copyright © 2011 Damani A. Piggott and Petros C. Karakousis. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The convergent human immunodeficiency virus (HIV) and tuberculosis (TB) pandemics continue to collectively exact significant morbidity and mortality worldwide. Highly active antiretroviral therapy (HAART) has been a critical component in combating the scourge of these two conditions as both a preemptive and therapeutic modality. However, concomitant administration of antiretroviral and antituberculous therapies poses significant challenges, including cumulative drug toxicities, drug-drug interactions, high pill burden, and the immune reconstitution inflammatory syndrome (IRIS), thus complicating the management of coinfected individuals. This paper will review data from recent studies regarding the optimal timing of HAART initiation relative to TB treatment, with the ultimate goal of improving coinfection-related morbidity and mortality while mitigating toxicity resulting from concurrent treatment of both infections.