A Trial of 2 Disease-Modifying Drugs (Metformin and N-acetylcysteine ) to Promote TB Lung Function Recovery

Inclusion Criteria: * Willing and able to provide signed written consent (or, in the case of illiteracy, witnessed oral consent plus patient thumbprint) prior to undertaking any trial-related procedures. * Body weight (in light clothing without shoes) between 30 and 90 kg. * Radiographic evidence of pulmonary tuberculosis * Positive Xpert TB/RIF (original or Ultra) for MTB * RIF susceptibility diagnosed by Xpert TB/RIF, with subsequent culture confirmation * FEV1≤65% of predicted * Eligible for treatment with a 6-month regimen comprised of INH, RIF, EMB, and PZA * If sexually active, willing to use effective contraceptive methods for a period of 9 months (3 months post-study treatment) * HIV-1 seronegative, or if HIV-1 seropositive, presenting to a non-India clinical site with a CD4 T cell count ≥100/µl and either receiving ART or willing to start ART during study participation * SARS-CoV-2 PCR or antigen test negative, or if positive, either fully vaccinated against Covid-19 or with D-dimer \<1 µg/ml * eGFR ≥30 ml/min/1.73 m2 (CKD EPI 2009) Exclusion Criteria: * Any condition for which participation in the trial, as judged by the investigator, could compromise the well-being of the subject or prevent, limit or confound protocol specified assessments * Currently pregnant or nursing, or pregnancy planned in next 12 months * Is critically ill, and in the judgment of the investigator has a diagnosis likely to result in death during the trial or the follow-up period. * TB meni…