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.
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