Empiric vs. Test-Guided TB Treatment in AIDS Patients Starting ART

In a randomized trial comparing empiric tuberculosis therapy versus test-guided therapy in AIDS patients starting ART, both strategies had similar rates of death or invasive bacterial disease.

Mortality rates are high for patients starting antiretroviral therapy (ART) with advanced AIDS and tuberculosis (TB). These investigators compared two management strategies in HIV+ patients naive to ART, with CD4 counts <100 cells/mm³, and without overt TB from Ivory Coast, Uganda, Cambodia, and Vietnam. Participants were randomized to empiric TB therapy (rifampin, isoniazid, ethambutol, and pyrazinamide for 2 months, then rifampin + isoniazid for 4 months) or guided TB therapy, i.e., only if supported by Xpert MTB/RIF testing, urinary lipoarabinomannan, and chest x-ray. Patients typically started ART (mainly tenofovir, efavirenz, and either lamivudine [3TC] or emtricitabine [FTC]) at week 2 with empiric therapy and promptly after enrollmen…

Reviewing Author

Keith Henry, MD

Disclosures

Consultant/Advisory BoardViiV Advisory Board

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes

Keith Henry, MD

Disclosures

Consultant/Advisory BoardViiV Advisory Board

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes

Empiric vs. Test-Guided TB Treatment in AIDS Patients Starting ART

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Reviewing Author