But there was a much bigger difference in patients in the worst shape in terms of HIV: 16 percent of those who received earlier treatment got worse or died, compared to 27 percent of those who received later treatment.
The finding suggests that "very sick patients must be started (on HIV drugs) immediately and early," Havlir said, but those who are doing better can wait eight weeks.
Farrar supported the findings of the studies and agreed that it's a good idea to start HIV treatment early in the patients whose HIV is most severe. It will save lives and could reduce transmission, he said.
But culture tests for TB are rare in areas lacking state-of-the-art medical resources, so diagnoses are often based on clinical observation of symptoms, Farrar said. Also, he noted that most of the patients in the studies had pulmonary tuberculosis, which is rarely life-threatening. Death rates are much higher for more severe forms, such as tuberculous meningitis.
Farrar also acknowledged other caveats. A regimen of many pills might lead to noncompliance among some patients, he said. For patients with drug-resistant tuberculosis, the medication schedule is even more daunting.
The possibility also exists of "complex interactions between the drugs for TB and HIV and other conditions the patients have," he said.
"We need a much greater understanding of this interaction and work to help deliver these crucial drugs in a better way," Farrar stated.
For more about tuberculosis, see the U.S. National Library of Medicine.
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