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Adjunctive corticosteroids are standard in many patients with tuberculous meningitis, but the evidence base in people with HIV-associated disease has been less certain. In a double-blind randomized trial of 520 HIV-positive adults with TB meningitis, dexamethasone was compared with placebo in addition to 12 months of antituberculous therapy. During one year of follow-up, mortality was not significantly different between the dexamethasone and placebo groups, and prespecified subgroup analyses did not identify a population with a clear survival benefit. Serious adverse events were also similar. The findings are clinically important because they show that evidence from HIV-negative TB meningitis cannot automatically be extrapolated to people living with HIV. For HCPs, treatment decisions should therefore follow disease-specific guidance and consider immune status, opportunistic infections and the risk of immune reconstitution inflammatory syndrome. The study also illustrates why apparently universal treatment practices may require separate evidence in immunocompromised populations. This is directly aligned with IANCON's focus on neuroinfections and neurological complications of systemic infection.
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Adjunctive corticosteroids are standard in many patients with tuberculous meningitis, but the evidence base in people with HIV-associated disease has been less certain. In a double-blind randomized trial of 520 HIV-positive adults with TB meningitis, dexamethasone was compared with placebo in addition to 12 months of antituberculous therapy. During one year of follow-up, mortality was not significantly different between the dexamethasone and placebo groups, and prespecified subgroup analyses did not identify a population with a clear survival benefit. Serious adverse events were also similar. The findings are clinically important because they show that evidence from HIV-negative TB meningitis cannot automatically be extrapolated to people living with HIV. For HCPs, treatment decisions should therefore follow disease-specific guidance and consider immune status, opportunistic infections and the risk of immune reconstitution inflammatory syndrome. The study also illustrates why apparently universal treatment practices may require separate evidence in immunocompromised populations. This is directly aligned with IANCON's focus on neuroinfections and neurological complications of systemic infection.
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