Loading ...

TOPLINE:

Corticosteroids neither reduce all-cause mortality nor increase serious adverse events in patients with HIV and tuberculosis coinfection.

METHODOLOGY:

• Researchers evaluated the efficacy and safety of corticosteroids in a meta-analysis of seven randomized controlled trials involving 1410 HIV-positive patients with tuberculosis (age, ≥ 14 years), 703 of which had received corticosteroids.
• Tuberculosis was confirmed in these patients via pathogen-positive samples or a clinical diagnosis, and infection sites included meningitis, pericarditis, pleural tuberculosis, and unspecified locations.
• The primary outcome measured was all-cause mortality at the longest follow-up in each trial, and the secondary outcome focused on serious adverse events as defined by individual trials.

TAKEAWAY:

• Overall, deaths occurred in 29.7% and 32.8% of patients who did and did not receive corticosteroids, respectively (pooled risk ratio [RR], 0.91; 95% CI, 0.79-1.04).
• Subgroup analyses showed no significant association between the infection sites, corticosteroid dosage, or treatment duration and all-cause mortality.
• Deaths resulting from serious adverse events were reported in four studies, with no significant difference noted in patients who did and did not receive corticosteroids (50.2% vs 51.6%; pooled RR, 0.96; 95% CI, 0.82-1.13).

IN PRACTICE:

“While this meta-analysis did not detect a significant increase in the risk of serious adverse events, clinicians must carefully weigh the anti-inflammatory benefits of corticosteroid therapy against the potential for further immune suppression in immunocompromised patients,” the authors wrote.

SOURCE:

The study was led by Jiaqi Pu, MD, West China Hospital, Sichuan University, Chengdu, China. It was published online on November 11, 2024, in Clinical Infectious Diseases.

LIMITATIONS:

Variability in parameters such as corticosteroid dosages and duration, administration timing, and outcomes could affect interpretation of the pooled results. In addition, as the study included individuals aged ≥ 14 years, the results cannot be generalized to special populations, such as pregnant women and patients with multidrug-resistant tuberculosis.

DISCLOSURES:

This study was conducted independently without any funding. No conflicts of interest were reported in this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.