Objectives
Tuberculosis symptoms are very common among people living with HIV (PLHIV) initiating
antiretroviral therapy (ART), are not specific for tuberculosis disease and may result in
delayed ART start. The risks and benefits of same-day ART initiation in PLHIV with tuberculosis
symptoms are unknown.
Methods
We systematically reviewed nine databases on 12 March 2020 to identify studies that
investigated same-day ART initiation among PLHIV with tuberculosis symptoms and reported
both their approach to TB screening and clinical outcomes. We extracted and summarised
data about TB screening, numbers of people starting same-day ART and outcomes.
Results
We included four studies. Two studies deferred ART for everyone with any tuberculosis
symptoms (one or more of cough, fever, night sweats or weight loss) and substantial numbers
of people had deferred ART start (28% and 39% did not start same-day ART). Two studies
permitted some people with tuberculosis symptoms to start same-day ART, and fewer people
deferred ART (2% and 16% did not start same-day). Two of the four studies were conducted
sequentially; proven viral load suppression at eight months was 31% when everyone with
tuberculosis symptoms had ART deferred, and 44% when algorithm was changed so that
some people with tuberculosis symptoms could start same-day ART.
Conclusions
Although tuberculosissymptoms are very common in people starting ART, there is insufficient
evidence about whether presence of tuberculosis symptoms should lead to ART start being
deferred or not. Research to inform clear guidelines would help maximise benefits of sameday ART.