Treating Tuberculosis and AIDS Together Saves Lives

New York Times

17/02/2014

 

By DONALD G. McNEIL Jr.

Patients who have multi-drug-resistant tuberculosis and AIDS are more likely to live if they get simultaneous treatment for both diseases rather than waiting weeks to start the AIDS treatment, a new study has found.

Although the study was small — it included only 23 South African patients with drug-resistant TB — its results concurred with those of three major studies of people with regular TB and the virus that causes AIDS.

Those three studies, said Dr. Gerald Friedland, a tuberculosis specialist at the Yale School of Public Health, overturned an old belief that it was safer to treat TB first and H.I.V. afterward.

The new study was published in The International Journal of Tuberculosis and Lung Disease.

The old fear was that weak TB patients would be killed by the inflammation and fluids released into their lungs when antiretroviral drugs jump-started their immune systems.

But “immune reconstitution” can usually be managed with anti-inflammatory drugs, Dr. Friedland said, and far fewer patients in the studies died when they received both therapies promptly.

The idea that waiting was best “goes back historically quite a ways,” he said, to the early days of AIDS, when tuberculosis treatment was a long-established specialty and its practitioners were unfamiliar with the new disease. Also, early H.I.V. drugs were more toxic, and patients had to take many pills every day. Since TB patients typically take a four-drug cocktail, pill regimens could become very complicated, and patients often quit.

A version of this article appears in print on February 18, 2014, on page D6 of the New York edition with the headline: Treating TB and AIDS Together Saves Lives