Tuberculous Meningitis in HIV Tough to Treat

Background: Steroids are often used in tuberculous (TB) meningitis, but benefits and risks are unclear for HIV-associated TB meningitis. Objective: To assess dexamethasone in HIV-associated TB meningitis. Design: Randomized, double-blind placebo-controlled trial. Participants: Patients recruited from hospitals in Vietnam and Indonesia. Eligible participants were HIV positive and initiating antituberculosis medication for definite, probable, or possible TB meningitis. More than half of participants had CD4 counts ≤50 cells/mm 3 . Only 15% had CD4 counts >200 cells/mm 3 . Methods: 520 patients underwent randomization to dexamethasone or placebo groups. Those with moderate to severe disease received 8 weeks of tapering dexamethasone or placebo, and those with mild disease received 6 weeks. All patients were given 12 months of antituberculosis medication. Antiretroviral therapy was initiated 6 to 8 weeks after initiating antituberculosis medication for those not previously on HIV ther more...