This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
Patient diagnosed with HIV and Tuberculosis. How to sta ATT and c-A.R.T 
Select and explain. 
A. Sta ATT first, B. Sta cA first, C. Sta both simultaneously, D. Sta cA only
A: Sta ATT first
Answer: A: Sta ATT first 
Explanation: Ans. is 'a' i.e., Sta ATT first In a case when HIV and TB are diagnosed together ATT should be staed first. ATT staed first, because of IRIS (Immune Reconstitution Inflammatory syndrome). If A staed first, it may improve CD4 cells at first, but later a previously acquired infection (TB, Herpes), responds with an overshelming inflammatory response that paradoxically makes the symptom of infection worse. Therefore, staing of ATT-2 weeks before A, have shown to decrease the incidence of IRIS.