A 45 years old male patient comes to OPD with cough and diarrhea since last 3 weeks. On diagnosis he is found to be HIV positive with Tuberculosis, Next line of management should be:-
Correct Answer: Sta ATT followed by A
Description: Guidelines for treatment of HIV+TB patients:- A is offered to all HIV-TB and HIV-MDR TB patients irrespective of CD4 count. Sta ATT first, allow it to be tolerated , then sta A. ATT treatment is same but treatment is more difficult and adverse reactions are more common. Immune reconstitution inflammatory syndrome (IRIS) : Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs ofradiographic manifestations of TB after beginning TB treatment. This paradoxical reaction occurs in HIV-infected patients with active TB and is thought to be a result of immune restitution due to the simultaneous administration of antiretroviral and tuberculosis medication. Symptoms and signs may include high fever, lymphadenopathy, expandingintra-thoracic lesions and worsening of chest radiographicfindings
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