Trials of anti-tuberculosis treatment in areas of high human immunodeficiency virus prevalence in sub-Saharan Africa

Sub-Saharan Africa is bearing the brunt of the human immunodeficiency virus (HIV) pandemic, and HIV-associated tuberculosis (TB) has become a major cl inical and public health problem. There is evidence that HIV-infected patie nts not uncommonly develop disseminated TB, and that this diagnosis is ofte n not made ante mortem because of limited diagnostic facilities and other f actors. Where diagnostic facilities are limited, a trial of anti-tuberculos is treatment with drugs specific for Mycobacterium tuberculosis may be a us eful way of diagnosing disseminated TB. The case for and against 'a trial o f treatment' is presented, and a suggestion is made that 'a trial of treatm ent' can be incorporated into the case finding package of a National TB Con trol Programme.