ARTICLE: Empirical Antituberculosis Therapy in Advanced HIV Disease - Too Much, Too Late
AUTHORS: Richard E Chaisson
JOURNAL: N Engl J Med. 2020 Jun 18;382(25):2459-2460. doi: 10.1056/NEJMe2009679.
Despite the extraordinary advances in treating human immunodeficiency virus (HIV) infection during the past two decades, mortality, especially in resource-limited areas, remains unacceptably high. The leading killer of persons with HIV infection in these areas is tuberculosis, which accounted for more than a quarter of a million deaths in 2018.1 Among persons with low CD4+ T-cell counts who start antiretroviral therapy (ART) in low- and middle-income countries, the risk of tuberculosis developing within 6 months after starting therapy is as high as 20%, which exacts a heavy burden in terms of suffering and death. Diagnosing tuberculosis in such patients is often difficult, because the clinical manifestations are protean and diagnostic tests have poor sensitivity. As a result, some clinicians have reasoned that administering empirical antituberculosis treatment to patients with advanced HIV infection who do not yet have tuberculosis could lower the risk of death.
For the full article, click here.
