Tuberculosis (TB) has been identified as a major, often overlooked cause of deadly sepsis among people with HIV in Africa, according to a new study. The ATLAS study, which took place over five years in hospitals in Tanzania and Uganda, found that more than half of the patients enrolled had TB. Immediate treatment for TB was shown to significantly improve survival rates.
The research was led by teams from the University of Virginia School of Medicine, Tulane School of Medicine, University of Minnesota, and collaborators from Africa. Key physician-scientists involved included Stellah Mpagama from Kibong'oto Infectious Diseases Hospital in Tanzania and Conrad Muzoora from Uganda's Mbarara University of Science and Technology.
"In life-threatening sepsis in other parts of the world, a germ causing infection is either not found or is commonly caused by bacteria from urinary tract infections or pneumonia," said Scott Heysell, MD, MPH, a researcher at UVA Health who co-led the study. "Instead, we found a treatable form of infection in the majority of people that could be targeted immediately when they presented to care."
Sepsis is a dangerous condition involving full-body inflammation that can lead to organ failure and death. It remains one of the leading causes of mortality globally, with people living with HIV being especially at risk.
The ATLAS study examined more than 400 patients with sepsis. It discovered that TB was not only common but also frequently unrecognized as the underlying cause. Patients who received immediate treatment for TB—even before receiving a formal diagnosis—had higher survival rates compared to those whose treatment was delayed until after confirmation.
Diagnosing TB quickly remains difficult in Eastern Africa because sophisticated blood tests are often unavailable or results are delayed. According to Mpagama: "many of these patients have multiple infections at the same time, which makes their care more challenging."
Current medical guidelines recommend starting TB treatment only after confirmation or if there is no improvement following standard therapy within three to five days. However, researchers suggest that beginning treatment earlier could save many lives each year.
"This study has the potential to provide a blueprint for evidence-based antimicrobial approach for sepsis therapy in TB-endemic areas," said Eva Otoupalova, MD, from Tulane. "My hope is that this work will help lower the extremely high mortality of patients with TB-sepsis."
Funding from the National Institutes of Health is supporting further research by this group in Uganda and Tanzania. A new clinical trial will test whether hydrocortisone for reducing inflammation or immediate treatment for TB and other bacterial infections can improve outcomes for patients with HIV-related sepsis.
Findings from this research have been published as open-access articles in Lancet Infectious Diseases and eClinicalMedicine.
The ATLAS project involved more than 30 healthcare professionals including doctors, nurses, pharmacists, coordinators and statisticians. The work was funded by several NIH grants: U01 AI150508, D43 TW012247, R21 AI172637 and K24 AI187675.
