Efficacy and Safety of Systematic Corticosteroids treatment among HIV-Positive Patients with Tuberculosis: a systematic review and meta-analysis of randomized controlled trials

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases Pub Date : 2024-11-11 DOI:10.1093/cid/ciae563

Jiaqi Pu, Shouquan Wu, Jian-Qing He

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引用次数: 0

Abstract

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 September 19, 2024. The primary outcome was all-cause mortality, while secondary outcomes included serious adverse events. A random-effects model calculated risk ratios (RR) with 95% confidence intervals (CIs). Result Seven RCTs involving 1,410 HIV-positive TB patients were included. Corticosteroid use was not significantly reduce all-cause mortality (RR = 0.91, 95% CI: 0.79-1.04, P = 0.17) and did not significantly increase serious adverse events (RR = 0.96, 95% CI: 0.82-1.13, P = 0.63). Conclusion This meta-analysis of seven RCTs involving 1,410 HIV-positive TB patients found that corticosteroid treatment neither significantly reduced all-cause mortality nor increased serious adverse events. Further large-scale RCTs with extended follow-up are needed to explore potential benefits in subgroups, optimize treatment protocols, and inform clinical guidelines.

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艾滋病毒阳性肺结核患者接受系统皮质类固醇治疗的有效性和安全性：随机对照试验的系统回顾和荟萃分析

简介：皮质类固醇对人类免疫缺陷病毒（HIV）和结核病（TB）患者的疗效和安全性仍存在争议。方法于 2024 年 9 月 19 日检索了 PubMed、Embase、Web of Science 和 Cochrane 数据库。主要结果为全因死亡率，次要结果包括严重不良事件。随机效应模型计算了风险比 (RR) 和 95% 置信区间 (CI)。结果共纳入了 7 项 RCT，涉及 1,410 名 HIV 阳性肺结核患者。使用皮质类固醇并未显著降低全因死亡率（RR = 0.91，95% CI：0.79-1.04，P = 0.17），也未显著增加严重不良事件（RR = 0.96，95% CI：0.82-1.13，P = 0.63）。结论对涉及 1,410 名 HIV 阳性肺结核患者的 7 项 RCT 进行的荟萃分析发现，皮质类固醇治疗既不会显著降低全因死亡率，也不会增加严重不良事件。需要进一步开展大规模的 RCT 研究并延长随访时间，以探索亚组的潜在益处、优化治疗方案并为临床指南提供参考。

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来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.