Reflections on the time of initiating ART in HIV-TB patients.

Adoption of trial results without careful analysis of all mortality data and validation in other settings may become an unwise departure from established practice. The CAMELIA study does not capture the anxiety and anguish of treating a life threatening ‘iatrogenic’ disease like IRIS. The difference between deferred treatment and immediate treatment may mean, in certain situations, the difference between preventing and actually creating a serious condition. ART initiation after attaining certain clinical milestones such as tolerance of all medication and some clinical response is more useful for the majority of patients seen at our centres rather than at an early fixed time point. Although several strategy trials examining the optimum timing of ART during opportunistic infections have found that early ART is beneficial, the question of the optimum timing clearly has more than one right answer.