In reply to `Empirical tuberculosis treatment or improved diagnostics?'

Abstract

We read the article by Lawn and colleagues with great interest. Atypical presentation and limited diagnostic capability in resource-limited settings lead to delays in treatment that could contribute to high rates of antiretroviral therapy (ART) associated TB. To address the potential role of empiric TB treatment in immunosuppressed patients first presenting for care, we proposed the ‘Prevention of early mortality by presumptive TB treatment in HIV-infected patients initiating antiretroviral therapy’ (PROMPT) study, which was funded by the European Developing Country Clinical Trials Programme (EDCTP) in October 2010. We have started enrolling 334 patients from four geographically diverse countries (Gabon, Mozambique, South Africa and Uganda) in a randomised open label clinical trial targeting a population of people with high mortality risk: patients with CD4 T-cell count <50 cells/μl and body mass index (BMI) < 18 kg/m2.