In 2007, it was estimated that there were about 33 million persons living with human immunodeficiency virus (HIV) infection and 9.2 million persons with newly diagnosed tuberculosis worldwide. The two diseases are closely intertwined, and the number of patients with coinfection continues to grow rapidly. Tuberculosis is the most common opportunistic disease and the most common cause of death in patients with HIV infection in developing countries.

Notwithstanding effective tuberculosis chemotherapy, in the presence of HIV infection, tuberculosis is associated with substantially increased case fatality rates and is also the most commonly reported cause of death in South Africa. In 2007 in South Africa, an estimated 5.3 million people were infected with HIV and 341,165 with tuberculosis, of whom approximately 73% were coinfected with HIV.

The optimal timing for the initiation of antiretroviral therapy in patients with HIV and tuberculosis coinfection remains unclear. Current guidelines are based on observational studies and expert opinion. Despite World Health Organization (WHO) guidelines supporting concomitant treatment of the two diseases and urging more aggressive management, the initiation of antiretroviral therapy is often deferred until completion of tuberculosis therapy because of concern about potential drug interactions between rifampin and some classes of antiretroviral drugs, the immune reconstitution inflammatory syndrome,overlapping side effects, a high pill burden, and programmatic challenges.

This study, called the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPIT) trial, was designed to determine the optimal time to initiate antiretroviral therapy in patients with HIV and tuberculosis coinfection who were receiving tuberculosis therapy.

See full report attached.