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HIV increases the likelihood that a person will develop TB. Starting them onanti-retroviral therapy (ART) reduces their risk of TB but not to the level inHIV negative people. Since HIV-positive people who are on ART can expect tolive a normal life for several decades this raises the possibility that theirelevated risk of infection, lasting for a long time, could lead to an increasein the population level incidence of TB. Here we investigate the conditionsunder which this could happen and show that provided HIV-positive people startART when their CD4+ cell count is greater than 350/microL and that there ishigh coverage, ART will not lead to a long-term increase in HIV. Only if peoplestart ART very late and there is low coverage of ART might starting people onART increase the population level incidence of TB.

Could ART increase the population level incidence of TB?