Question

Should my friend start ART with their TB meds?

22 May 2020. Related: All topics, Complications and coinfections, Side effects, Southern Africa, Starting treatment, TB.

My friend was dignosed with HIV and TB about two months ago and was very sick.

Her CD4 count was only 38 and she was immediately put on TB treatment for 6 months. Her condition has since improved although she sometimes complains from aching feet.

She is not keen on commencing ART and prefers to use boosters.

My questions are: (1) will TB meds alone improve her CD4 count? (2) Is it safe to use boosters while on TB meds? (3) Does she have to wait until she is off TB meds before commencing ARVs or she can take them together?

I am in South Africa.

Answer

Answer: Simon Collins

Hi

Thanks for your questions.

First though, your friend is really lucky to have been diagnosed in time to be treatment. Even if things are difficult now, they will get easier and better. She will need to use both HIV meds (ART) and TB meds, usually starting with TB meds and then using ART afer a couple of weeks,

Because your friend has a very low CD4 count (less than 50) it is important to use HIV meds (ART) as well as the TB meds. She should also ask her doctor to look at her eyes, because of a risk of CMV.

Several studies, including research in South Africa, showed that starting ART early is important for your friends health. Although these are technical, a summary of these studies is at this link.

Please ask your friend to talk to her doctor about the aching feet. This may be something called peripheral neuropathy and can be related to advanced HIV but it can also be a side effect of the TB meds.

The TB meds will not increase the CD4 count. The only way to increase her CD4 count is to use HIV meds (ART). I am sorry but there is no such thing as an immune booster. Companies that advertise immune boosters are just taking your money. These supplement will not have any impact on your CD4 count.

Your friend needs TB drugs to treat the TB and ARVs to treat the HIV. She would be better to spend her money on good food than wasting it on so-called ‘boosters’.

Further info

TB and HIV coinfection (from the i-Base training manual)
https://i-base.info/ttfa/5-ois-and-coinfections/7-tuberculosis-tb

UK (BHIVA) guidelines on HIV and TB coinfection.
https://www.bhiva.org/TB-guidelines

This answer to this question from 2011 was updated in May 2020..