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Doctor Calls for Rethinking TB Treatment Guidelines for HIV Patients

In the middle of the last century, many medical scientists believed they had conquered tuberculosis. But as HIV emerged in the 1980's, TB made a comeback. Today, worldwide, the disease claims some 2 million lives a year and about 8 million people are newly diagnosed.

Doctor Payam Nahid, a pulmonologist and TB researcher from the University of California in San Francisco says TB is a major problem for people with HIV. The virus makes them more susceptible to TB, and TB makes those patients' HIV worse. Based on what he saw in his clinic in California, Nahid began to question current treatment guidelines for TB that include a 6-month course of antibiotics for everyone.

"To me it seems counterintuitive to conceive that TB could be managed exactly the same way in an HIV-affected patient as in an HIV-unaffected patients," Nahid says.

He reviewed more than a decade of data covering 700 patients, looking at the cure rates for his TB patients, both with and without HIV. "The first notable finding was that HIV-infected patients with active tuberculosis were more likely to have a second episode of tuberculosis after completing treatment and establishing cure, as compared to those who were [not infected] with HIV."

Nahid says he also found that the length of treatment affected the outcome. The longer HIV patients took antibiotics, the less likely they were to have a recurrence of the TB. He says this calls the treatment guidelines of six months of TB therapy for HIV patients into question.

Treatment guidelines are developed in response to clinical trials, with "a whole army of people making sure there's good adherence, [and] the therapies are all given in a very controlled fashion," Nahid says. "The study that we completed is, essentially, a real life equivalent of that and comes with all the complexities of all the demographics of the patients."

Nahid hopes other researchers will now look back at actual treatment outcomes for tuberculosis patients with HIV. Maybe, he adds, it's time to revise some of those guidelines.