{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T02:27:37Z","timestamp":1774492057541,"version":"3.50.1"},"reference-count":22,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,6,23]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the effect of adjunctive corticosteroids on mortality in persons living with HIV (PLHIV) being treated for tuberculosis (TB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, CENTRAL and EMBASE through 31 December 2023<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study selection<\/jats:title>\n                    <jats:p>Randomised placebo-controlled trials (RCTs) with published Kaplan-Meier survival curves comparing corticosteroids versus placebo in PLHIV receiving TB treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Quality assessment, data extraction and analysis<\/jats:title>\n                    <jats:p>Three reviewers independently assessed study quality and extracted data. Reconstructed individual patient data were derived from published Kaplan-Meier survival curves, and a one-stage mixed-effects Cox regression model was used to estimate HRs for all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four trials involving 873 PLHIV with three forms of TB (618 meningitis, 197 pleural and 58 pericarditis) were included. Over a median follow-up of 19.3 months (IQR, 15.1\u201330.2), 367 (42%) participants died. At 12 months after randomisation, corticosteroids were associated with a 67% reduction in mortality (HR 0.33, 95%\u2009CI 0.26 to 0.41; p&lt;0.0001) compared with placebo. This benefit was maintained during the full follow-up period, with a 17% reduction in mortality (0.83, 0.68\u20130.99; p=0.0477). In subgroup analyses, a non-significant trend towards benefit was seen for TB meningitis (HR 0.84, 0.67\u20131.05; p=0.061, two trials), with unclear effect for pleural (HR 0.90, 0.57\u20131.41; p=0.643, one trial) and TB pericarditis (HR 0.40, 0.15\u20131.17; p=0.100, one trial).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjunctive corticosteroids were associated with reduced mortality among PLHIV treated for TB in this meta-analysis of four RCTs. Further clinical trials are needed to confirm this finding and inform guidelines on the use of adjunctive corticosteroid in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024500865.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-017923","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T09:30:24Z","timestamp":1755163824000},"page":"e017923","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Corticosteroids for reducing tuberculosis mortality in persons living with HIV: a systematic review and meta-analysis using reconstructed individual patient data"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1666-8641","authenticated-orcid":false,"given":"Alhassane","family":"Diallo","sequence":"first","affiliation":[{"name":"Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Conakry, Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boubacar Djelo","family":"Diallo","sequence":"additional","affiliation":[{"name":"National Tuberculosis Program, Conakry, Guinea"},{"name":"Pneumology, Universite Gamal Abdel Nasser de Conakry, Conakry, Conakry, Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oumou Hawa","family":"Diallo","sequence":"additional","affiliation":[{"name":"Pneumology, Universite Gamal Abdel Nasser de Conakry, Conakry, Conakry, Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Carlos-Bolumbu","sequence":"additional","affiliation":[{"name":"Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Conakry, Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Camara","sequence":"additional","affiliation":[{"name":"Facult\u00e9 des Sciences et Techniques de la Sant\u00e9, Universit\u00e9 Gamal Abdel Nasser de Conakry, Conakry, Guin\u00e9e, Conakry, Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7905-9042","authenticated-orcid":false,"given":"Sidibe","family":"Sidikiba","sequence":"additional","affiliation":[{"name":"University of Conakry. Public health Department, Universite Gamal Abdel Nasser de Conakry Faculte des Sciences et Techniques de la Sante, Conakry, Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"2025081402301731000_10.8.e017923.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbr.2019.11.013"},{"key":"2025081402301731000_10.8.e017923.2","unstructured":"World health organization: global tuberculosis report 2023. 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