For a patient with HIV who tests positive for TB, what is the first step in treatment?

For a patient with HIV who tests positive for tuberculosis (TB), the first step in treatment is to conduct cultures for TB. This is crucial because it helps confirm the diagnosis of active TB and determines the susceptibility of the bacteria to various antitubercular medications. Proper identification of the strain of TB through culture is essential for guiding effective treatment.

In patients with HIV, the complexity of managing concurrent infections is heightened; hence, accurately diagnosing and assessing the type of TB is extremely important. While antiretroviral therapy is vital for managing HIV, it is not the immediate step when a patient tests positive for TB without proper confirmation. Initiating directly observed therapy (DOT) for TB may also follow later confirmation of the TB diagnosis, and pulmonary function tests, while potentially relevant in the broader assessment of lung health, are not the immediate priority in addressing the suspected TB.