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Empirical TB treatment comes up short again
Theo Smart, 2016-02-26 10:00:00

A South African trial has found that a strategy allowing primary care nurses to quickly provide empirical tuberculosis (TB) treatment for newly diagnosed people with advanced HIV disease at very high risk of, but without confirmed, TB did not lead to a major reduction in mortality, even though it substantially increased the percentage of people starting TB treatment. Moreover, it may have delayed initiating antiretroviral therapy (ART) for some participants when compared to those in a standard of care control arm, researchers say.

"I think from this we can say that increased TB treatment coverage alone did not result in a major reduction in early mortality," said Dr Alison Grant of the London School of Hygiene and Tropical Medicine and Aurum Institute who presented the findings on the final day of the annual Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston.  

She and other experts at the meeting suggested that the delay in ART initiation could have offset some of the benefit earlier TB treatment may have offered. However, the results seemed quite similar to those of the REMEMBER trial, reported last year, which found that putting everyone with a CD4 cell count below 50 cells/mm3 on both ART and empirical TB treatment was no better than offering ART and isoniazid preventive therapy (IPT).