Table 3.

Recommendations for individuals with tuberculosis (TB) disease and HIV coinfection.

CD4 cell count, cells/mm3	Recommended regimen	Comments
<200	Start TB treatment; start ART as soon as TB treatment     is tolerated (between 2 weeks and 2 months);a use     EFV-containing regimensb,c,d	Recommend ART; EFV is contraindicated in pregnant women     or women of childbearing potential without effective     contraception
200–350	Start TB treatment; start one of the following regimens     after the initiation phase (start earlier if patient is     severely compromised): EFV-containing regimensb     or NVP-containing regimens in case of a rifampin-free     continuation-phase TB treatment regimen	Consider ART
>350	Start TB treatment	Defer ARTe
Not available	Start TB treatment	Consider ARTa,f

NOTE. Adapted from the World Health Organization [36]. ART, antiretroviral therapy; EFV, efavirenz, NVP, nevirapine.

^aTiming of ART initiation should be based on clinical judgment in relation to other signs of immunodeficiency. For patients with extrapulmonary TB, ART should be started as soon as TB treatment is tolerated, irrespective of CD4 cell count.

^bAlternatives to the EFV portion of the regimen include saquinavir (SQV)/ritonavir (RTV) (400/400 mg twice daily), SQV/low-dose ritonavir (SQV/r) (1600/200 mg daily in soft gel capsule), lopinavir/RTV (400/400 mg twice daily), and abacavir.

^cNVP (200 mg daily for 2 weeks, followed by 200 mg twice daily) may be used in place of EFV in the absence of other options. NVP-containing regimens include stavudine (d4T)/lamivudine (3TC)/NVP or zidovudine (ZDV)/3TC/NVP.

^dEFV-containing regimens include d4T/3TC/EFV and ZDV/3TC/EFV.

^eUnless non–TB stage IV conditions are present; otherwise, initiate ART on completion of TB treatment.

^fIf no other signs of immunodeficiency are present and the patient is improving while receiving TB treatment, ART should be started on completion of TB treatment.