Diagnosing Tuberculosis in People With Advanced Human Immunodeficiency Virus: More Is Needed

(See the Major Article by Matoga et al on pages e870–7.) Despite tremendous advances in human immunodeficiency virus (HIV) prevention, treatment, and care in the past 30 years, people living with HIV (PLHIV) who have advanced immunosuppression remain at an unacceptably high risk of death. Tuberculosis (TB) is the leading cause of death in PHIV and is especially prevalent and deadly in people with low CD4 cell counts. Suboptimal TB diagnostics contribute substantially to the problem. As three randomized trials (Reducing Early Mortality and Morbidity by Empiric TB Treatment [REMEMBER] [1], TB Fast Track [2], and Systematic or Test Guided Treatment for Tuberculosis in HIV-infected Adults [STATIS] [3]) have shown no benefit from empiric TB treatment, there is an urgent need to refocus on how to optimize and intensify TB screening in order to reduce deaths. Advanced HIV (defined by World Health...