In a patient with a positive TB test and a positive chest X-ray, when should immunotherapy be deferred?

• A. Immediately after positive TB test
• B. Until after completion of latent TB treatment
• C. After completion of TB treatment
• D. After liver function normalization

Answer: (C)

When there is evidence of active tuberculosis, you treat the TB first and only start immunotherapy after completing the TB treatment. A positive TB test plus a positive chest X-ray in this context suggests active TB, so immunotherapy should be deferred until the anti-TB regimen is finished and the patient is clinically and microbiologically stable. This approach helps control the infection, reduces the risk of TB progression or reactivation, and avoids potential drug interactions and immune-related complications. Delaying until after latent TB treatment isn’t appropriate here since the disease appears active, and waiting for liver function to normalize isn’t the primary trigger for timing immunotherapy.