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.