NEJM: Options for anti-tuberculosis options for HIV patients - system therapy vs testing guided treatment

In areas where TB and AIDS are burdened, many patients infected withHIV inbegin antiretroviral therapy (ART) aftersevere impairment of immunefunction, and tuberculosis and invasive bacterial diseases are common causes of deathresearchers recently conducted a 48-week empirical treatment trial for tuberculosis, with HIV infection patients who had not previously received ART treatment and had CD4-T cells counted below 100 cells per cubic millimeter, and were randomly assigned to receivescreening(Xpert-MTB/RIF trial, urine lipid Arab) Glycolyse tests and chest X-rays) to determine whether to start TB treatment (test guidance group), or to receive systematic treatment of rifampin, isoniazid, ethyl butylycol and pyridine, for a period of 2 months, followed by conversion to rifampin and isoniazid therapy for a period of 4 months (systemic treatment group)The main endpoint of the study was death of any cause or invasive bacterial disease within 24 weeks (or 48 weeks) of random grouping522 patients in thesystem treatment group and 525 patients in the treatment group were testedAt the 24th week, the mortality rate for any cause or invasive bacterial disease per 100 patients was 19.4 in the systemic treatment group and 20.3 cases in the test-guided treatment group (adjusted risk ratio of 0.95)In week 48, the corresponding ratios were 12.8 and 13.3 (adjusted risk ratio: 0.97)At week 24, the incidence of tuberculosis in systematic treatment was lower than that of test-guided treatment (3.0% vs 17.9%; correction risk ratio: 0.15), but the rate of adverse drug-related events in level 3 or 4 of the system therapy group was higher (17.4% vs 7.2%; correction risk ratio: 2.57)Severe adverse events in the systemic treatment group are more commonin HIV-infected adults who had not previously received ART treatment for immunodeficiency, TB system treatment regimens were not superior to the experimental-guided treatment group in reducing mortality or invasive bacterial disease risk at 24 or 48 weeks, and the risk of adverse events increased