Early TB Treatment Cuts Sepsis Deaths in HIV Patients

Study finds tuberculosis is a major cause of deadly sepsis among people living with HIV.

Feb. 7, 2026 at 2:55am

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A new study has found that starting tuberculosis (TB) treatment immediately, even before a TB diagnosis is confirmed, could significantly reduce sepsis deaths among HIV patients. The ATLAS trial found that early anti-TB treatment saved 1 in every 4 patients. The study also found that combined urine and sputum testing missed 32% of Mtb bloodstream infections, highlighting the need for improved TB diagnostic tools.

Why it matters

Sepsis is a leading global cause of hospital deaths, and Africa bears the world's highest burden of sepsis, with an estimated 48 million cases each year leading to about 11 million deaths. People living with HIV face the greatest risk of dying from the condition. This study provides a potential solution to reduce sepsis deaths in this vulnerable population.

The details

The study and ATLAS trial were conducted by Tulane University and University of Virginia in collaboration with Mbarara University in Uganda and the Tanzania's Kibong'oto Infectious Diseases Hospital. The ATLAS trial found that immediately treating HIV-related sepsis patients with anti-TB medication caused a 23% reduction in mortality when compared to those who only received treatment after receiving a TB diagnosis. The follow-up study examining the outcomes of the trial found that Mtb, the bacteria that causes TB, was the most common pathogen, detected in 52% of HIV-related sepsis patients.

  • The study and ATLAS trial were published in 2026.

The players

Dr. Eva Otoupalova

An assistant professor of Pulmonary and Critical Care Medicine at Tulane University School of Medicine, who co-led the study and was also an author on the ATLAS trial.

Tulane University

A university that collaborated on the study and ATLAS trial.

University of Virginia

A university that collaborated on the study and ATLAS trial.

Mbarara University

A university in Uganda that collaborated on the study and ATLAS trial.

Kibong'oto Infectious Diseases Hospital

A hospital in Tanzania that collaborated on the study and ATLAS trial.

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What they’re saying

“Our analysis of the clinical trial results found that Mtb (the bacteria that causes TB) is a much more common cause of sepsis that we thought. Usually, anti-TB treatments are reserved for those diagnosed with TB. We found that, in African hospitals where HIV and TB are a common co-infection, patients with sepsis may benefit from being given anti-TB medications as soon as possible.”

— Dr. Eva Otoupalova, Assistant Professor of Pulmonary and Critical Care Medicine, Tulane University School of Medicine

“Previous studies have shown that TB can cause sepsis, however those studies are few, and I don't think we realized how high the prevalence is. Our analysis also found that our diagnostic tools are missing a lot of TB-sepsis, which is impactful if anti-TB treatment is only given to those diagnosed with the disease.”

— Dr. Eva Otoupalova, Assistant Professor of Pulmonary and Critical Care Medicine, Tulane University School of Medicine

What’s next

The findings highlight the need for both earlier treatment and improved TB diagnostic tools to better detect TB-related sepsis in HIV patients.

The takeaway

This study provides a potential solution to reduce sepsis deaths in HIV patients by showing that early treatment with anti-TB medication, even before a TB diagnosis is confirmed, can significantly lower mortality rates. The findings underscore the need for improved diagnostic tools to detect TB-related sepsis, which is currently being missed by existing tests.