This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Tuberculosis, Subject name: Medicine
A patient is diagnosed with HIV and Tuberculosis. How should ATT and c-A.R.T be staed? 
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: Initiation of cA and/or anti-TB therapy may be associated with clinical deterioration due to immune reconstitution inflammatory syndrome (IRIS) reactions. These are most common in patients initiating both treatments at the same time, and may occur as early as 1 week after initiation of therapy, and are seen more frequently in patients with advanced HIV disease. For these reasons it is often recommended that initiation of cA be delayed in antiretroviral-naive patients until 2-8 weeks following the initiation of treatment for TB.