• Proportion of participants who have survived without AIDS progression [ Time Frame: Through Week 48 ] [ Designated as safety issue: Yes ]
  

TB is the most important coinfection in the HIV epidemic; the bi-directional relationship between the two diseases is well established. HIV increases the risk for TB acquisition, reactivation, and reinfection, and reduces survival compared to patients with TB alone. In individuals with HIV, TB infection results in reduced survival, increased risk for opportunistic infections, and elevations in HIV replication. Improving the outcome of HIV infected individuals who develop TB is of high importance. Initiating ART shortly after initiating TB treatment may improve outcomes in individuals coinfected with HIV and TB. However, data to support this suggestion are limited. This study will determine the most appropriate time to initiate ART in HIV infected individuals who recently initiated treatment for TB.

This study will last 48 weeks and will comprise two steps. At study entry, participants will undergo clinical assessment, drug adherence training, and blood collection. In Step 1, participants will be randomly assigned to one of two arms. Participants in Arm A will initiate ART within 2 weeks after initiating TB treatment. Participants in Arm B will defer ART until 8 to 12 weeks after initiation of their TB treatment. In Step 2, Arm B participants will initiate ART; Arm A participants will not enter Step 2. ART will consist of efavirenz and emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF); FTC and TDF may be given as individual agents. Drug substitutions may be made for participants who cannot tolerate the specified regimen. Blood collection and clinical assessments will occur at Weeks 4, 8, 12, 16, 24, 32, 40, and 48.