Effects of a Protein Calorie Supplement in HIV-infected Women With Tuberculosis (DarDar)

• Change in CD4 count [ Time Frame: Baseline to 8 months ] [ Designated as safety issue: No ]
  We will calculate change in CD4 count from start of ART until 6 mos on ART
  
  

• BMI at 6 months [ Time Frame: baseline to 6 months ] [ Designated as safety issue: No ]
  BMI will be compared between the two treatment groups
  
  
• Proportion of subjects who achieve 100 cell increase in CD4 [ Time Frame: baseline to 8 months ] [ Designated as safety issue: No ]
  % of subjects in 2 treatment groups who achieve 100 cell increase in CD4 will be compared
  
  

The objective of this randomized, controlled trial is to determine if adding a protein-calorie supplement (PCS) to the standard treatments for tuberculosis (TB) and HIV will improve health outcomes. The investigators will enroll 180 HIV-positive women with newly diagnosed active TB and without prior anti-retroviral therapy (ART). At baseline, the investigators will conduct dietary interviews, measure body composition, randomize subjects to receive a PCS (plus micronutritional supplements [MNS]) or control (MNS only) for the 6-month duration of anti-TB therapy (ATT) plus an additional 2 mos (8 mos total). Subjects will be followed monthly and have CD4 counts at baseline, 2, 8 and 12 months. At 2 months (i.e., at the end of the 4 drug intensive phase of TB treatment and start of the 2 drug continuation phase), all subjects will be started on anti-retroviral therapy (ART) based on Tanzanian Ministry of Health guidelines (currently: AZT/3TC/efavirenz). The primary endpoint will be change in CD4 count after 8 months (i.e., at end of PCS/MNS intervention and 2 months after completion of ATT).