Efficacy and Safety of Systematic Corticosteroids Treatment Among Patients With HIV and Tuberculosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

INTRODUCTION: The efficacy and safety of corticosteroids in patients with human immunodeficiency virus (HIV) and tuberculosis (TB) remain controversial. METHOD: PubMed, Embase, Web of Science, and the Cochrane Database were searched on 19 September 2024. The primary outcome was all-cause mortality, whereas secondary outcomes included serious adverse events. A random-effects model calculated risk ratios (RR) with 95% confidence intervals (CIs). RESULTS: Seven randomized controlled trials (RCTs) involving 1410 HIV-positive TB patients were included. Corticosteroid use did not significantly reduce all-cause mortality (RR = 0.91, 95% CI: .79-1.04, P = .17) and did not significantly increase serious adverse events (RR = 0.96, 95% CI: .82-1.13, P = .63). CONCLUSIONS: This meta-analysis of 7 RCTs involving 1410 HIV-positive TB patients found that corticosteroid treatment neither significantly reduced all-cause mortality nor increased serious adverse events. Furthermore, large-scale RCTs with extended follow-up are needed to explore potential benefits in subgroups, optimize treatment protocols, and inform clinical guidelines.