Although we don`t have details of pretreatment condition, most children with HIV/TB should get ART underway before completing ATT, as you have done. Two important questions, though, are how convinced are you of the diagnosis of TB, and what is the status of the HIV? Assuming TB is fairly likely, and the indications for ART also strong, it would probably not do the child harm to delay the ART for a few more weeks. However, this is a dangerous time for interrupting the ART, as the child would not be fully suppressed while the EFV remained in system for the next few weeks. So it would be necessary to continue the D4T/3TC for a couple more weeks to cover the EFV "tail". D4T & 3TC are generally well-tolerated initially, so I`d be more suspicious of the EFV- although that also is generally well tolerated. This may be an immune reconstitution syndrome, or it may be the ATT drugs alone. So I`d stop EFV, continue d4T/3TC for 2 weeks, follow SGPT, and restart full HAART in 4-6 weeks. If the liver status continues to worsen, think of other causes, including the ATT. |
