Upon diagnosing a patient with pulmonary tuberculosis and HIV, what is the recommended approach to treatment?

The recommended approach to treating a patient with pulmonary tuberculosis (TB) and HIV involves multiple aspects of care due to the complexities of co-infection. Starting anti-TB treatment is crucial; however, with the presence of HIV, careful attention to the timing of antiretroviral therapy (ART) is also necessary.

In cases where a patient's CD4 count is critically low, particularly below 50 cells per cubic mL, initiating ART within 2 weeks is advised to help reduce the risk of opportunistic infections and improve overall immune function. This timing is significant because the patient is at a higher risk for severe complications related to immunosuppression.

Additionally, providing co-trimoxazole prophylaxis is recommended for all patients with HIV who have a CD4 count below 350 cells per cubic mL, or specifically below 200 cells per cubic mL in some guidelines, to prevent other infections such as Pneumocystis pneumonia.

Therefore, the recommended approach encompasses starting anti-TB treatment, considering the urgent initiation of ART based on the patient's CD4 count, and administering prophylaxis to prevent further infections. This comprehensive strategy ensures the patient's immediate TB needs are met while also addressing the long-term management of HIV and reducing the risk of