Corticosteroids Show No Benefit for HIV Patients with Tuberculosis
A recent meta-analysis published in Clinical Infectious Diseases challenges the use of corticosteroids in treating HIV-positive individuals with tuberculosis (TB) coinfection. The study, led by Dr. Jiaqi Pu of West China Hospital, Sichuan University, found no significant reduction in all-cause mortality or increase in serious adverse events among patients who received corticosteroids compared to those who did not.
The extensive analysis pooled data from seven randomized controlled trials, encompassing 1410 HIV-positive patients aged 14 and older with confirmed TB. This included patients with various forms of TB, such as meningitis, pericarditis, and pleural TB. A total of 703 patients received corticosteroids as part of their treatment regimen.
The researchers’ primary outcome measure was all-cause mortality, tracked to the longest follow-up point in each trial. Secondary outcomes focused on serious adverse events, as defined within each individual study. The results were striking: “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),” the study reported. This indicates no statistically significant difference in mortality rates between the two groups.
Further subgroup analyses, exploring factors like infection site, corticosteroid dosage, and treatment duration, also failed to reveal any significant impact on mortality. Similarly, the analysis of serious adverse events, based on data from four of the included studies, showed no significant difference between the corticosteroid and non-corticosteroid groups (“50.2% vs 51.6%; pooled RR,0.96; 95% CI, 0.82-1.13”).
Despite the lack of increased adverse events in this study, the authors caution against widespread corticosteroid use in this population. “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,” they wrote. This highlights the delicate balance between potential benefits and the risks of further weakening the already compromised immune systems of these patients.
The study, published online November 11, 2024, in Clinical Infectious Diseases, acknowledges limitations. Variability in corticosteroid dosages, treatment durations, and governance timing across the included trials could influence the interpretation of the pooled results. Moreover,the age restriction (≥14 years) limits the generalizability of the findings to specific populations,such as pregnant women and patients with multidrug-resistant TB.
Importantly, the research was conducted independently without external funding, and no conflicts of interest were reported.
This research has significant implications for the treatment guidelines of HIV-positive individuals with TB coinfection in the United States and globally, prompting a reevaluation of corticosteroid use in this vulnerable population.
The full study is available here.
