Under India's National Tuberculosis Elimination Programme (NTEP), which of the following best describes the current policy on treatment of drug-susceptible TB in HIV-positive patients?

• A Anti-TB therapy (ATT) should be initiated first and ART started after 2 months of ATT
• B ART is given priority and ATT is withheld for 6 weeks
• C ATT should be started first and ART initiated within 2 weeks in all HIV-TB patients regardless of CD4 count ✓
• D Both ATT and ART are started simultaneously on the same day in all cases

Explanation

Current NTEP/WHO guidelines recommend starting ATT first and then initiating ART within 2 weeks of ATT in all HIV-TB co-infected patients, regardless of CD4 count, to reduce early mortality from immune reconstitution or opportunistic infections. The only exception where ART can be deferred to 8 weeks is in patients with CD4 count >50 cells/mm³ with TB meningitis, to reduce IRIS risk. Early ART initiation in all others reduces mortality significantly.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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