علاج التهاب السحايا السلي لدى البالغين المصابين بعدوى مشتركة بفيروس نقص المناعة البشرية

References

• Population: adults in hospital requiring treatment for tuberculous meningitis with HIV co-infection.
• Is there HIV co-infection? — high certainty of evidence, weak recommendation for use of adjunctive corticosteroids in people living with HIV; decision should be made on a case-by-case basis.
• Adults: RHZE with quinolone if at high risk of isoniazid resistance.
• In the absence of an effective alternative adjunctive therapy for HIV-associated tuberculous meningitis, and given the safety and potential effectiveness of corticosteroids, their use is recommended on a case-by-case basis in people living with HIV.
• If not already on ART, initiate at week 4–8 unless there is a clinical need for earlier initiation; if CD4 count less than 50 cells per mm³, consider ART at 2 weeks where there is an urgent clinical need.
• These limited data inform the weak recommendation to defer antiretroviral therapy for 4–8 weeks after starting tuberculosis treatment, in agreement with WHO and other guidelines.

DOI: 10.1016/S1473-3099(25)00364-0