HIV and Leprosy in the Eastern United States

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Abstract
To the Editor—The management of patients with coexisting HIV and Mycobacterium tuberculosis infections is complicated by multiple issues, including the timing of the initiation of highly active antiretroviral therapy (HAART), potential complex drug interactions and additive adverse effects, and the possibility of developing an immune reconstitution inflammatory syndrome (IRIS) that may be severe. According to the current recommendations from the Department of Health and Human Services (DHHS), HAART (which is usually indicated for patients with a CD4+ cell count of 3 or a history of an AIDS‐defining illness) should be withheld from HIV‐positive patients with concomitant tuberculosis—with the possible exception of patients with a CD4+ cell count of 3—until 4–8 weeks after initiation of the multidrug regimen for tuberculosis [1]. The recent retrospective study by Dheda et al. has suggested that HAART reduces the risk of death and new AIDS‐defining illnesses in HIV‐positive patients requiring treatment for tuberculosis and that delaying HAART in patients with a CD4+ cell count of 3 may increase the risk of death or developing an opportunistic infection [2].