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.

中文翻译：

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系统性皮质类固醇治疗 HIV 阳性结核病患者的疗效和安全性：随机对照试验的系统评价和荟萃分析


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 PubMed、Embase、Web of Science 和 Cochrane 数据库。主要结局是全因死亡率，而次要结局包括严重不良事件。随机效应模型计算了风险比 （RR） 和 95% 置信区间 （CIs）。结果 共纳入 7 例 RCT，涉及 1,410 例 HIV 阳性 TB 患者。皮质类固醇的使用没有显著降低全因死亡率 （RR = 0.91,95% CI： 0.79-1.04，P = 0.17），也没有显著增加严重不良事件 （RR = 0.96,95% CI： 0.82-1.13，P = 0.63）。结论 这项对涉及 1,410 名 HIV 阳性结核病患者的 7 项 RCT 的荟萃分析发现，皮质类固醇治疗既未显著降低全因死亡率，也未增加严重不良事件。需要进一步进行大规模 RCT 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信息。