New Study Identifies Tuberculosis as Overlooked Cause of Deadly Sepsis in HIV Patients
Sepsis, a critical condition where the body's response to infection damages tissues and organs, remains a leading global cause of hospital deaths. Africa experiences the highest burden of sepsis, with an estimated 48 million cases annually, leading to approximately 11 million deaths. People living with HIV face the greatest risk of dying from the condition.
A new study has identified tuberculosis (TB), a chronic bacterial lung disease, as a significant and previously overlooked cause of deadly sepsis among people living with HIV.
The associated Phase 3 clinical trial, known as the ATLAS study, found that initiating tuberculosis treatment immediately, even before a TB diagnosis is confirmed, could significantly reduce sepsis deaths among HIV patients.
Collaborative Research and Key Findings
The study and ATLAS trial were a collaborative effort, conducted by Tulane University and University of Virginia in conjunction with Mbarara University in Uganda and Tanzania's Kibong'oto Infectious Diseases Hospital, among other institutions. The findings were published in Lancet E-Clinical Medicine and Lancet Infectious Disease, respectively.
Dr. Eva Otoupalova, an assistant professor of Pulmonary and Critical Care Medicine at Tulane University School of Medicine and co-lead of the study, highlighted the impact of their analysis. She stated that their review of the clinical trial results found Mtb (the bacteria that causes TB) to be a much more common cause of sepsis than previously thought.
Dr. Otoupalova indicated that in African hospitals where HIV and TB are common co-infections, patients with sepsis may benefit from receiving anti-TB medications as soon as possible.
ATLAS Trial Results: Early Treatment Reduces Mortality
The ATLAS trial provided compelling evidence for early intervention.
Immediately treating HIV-related sepsis patients with anti-TB medication resulted in a 23% reduction in mortality compared to those who received treatment only after a TB diagnosis. This outcome suggests early anti-TB treatment saved 1 in every 4 patients.
It's important to note that an immediate but higher dose of the same medication was not associated with a decrease in mortality.
Diagnostic Gaps and Future Needs
A follow-up study, examining the outcomes of the trial, further underscored the prevalence of TB. Mtb was the most common pathogen, detected in 52% of HIV-related sepsis patients.
Dr. Otoupalova pointed out a critical issue: diagnostic tools are missing a significant number of TB-sepsis cases, which has implications if anti-TB treatment is only administered to those with a confirmed diagnosis. Researchers found that combined urine and sputum testing missed 32% of Mtb bloodstream infections.
These findings highlight the urgent need for both earlier treatment and improved TB diagnostic tools to combat sepsis deaths effectively.