Tuberculous meningitis in patients aged 19 years or younger who are living with HIV presents a distinct clinical scenario. The coexistence of HIV co-infection influences treatment decisions and the strength of evidence supporting specific interventions.
This protocol is intended for paediatric and adolescent patients aged 19 years or younger with confirmed tuberculous meningitis and HIV co-infection. Evidence in this population supports treatment decisions made on a case-by-case basis, reflecting a weak recommendation with high certainty of evidence for those living with HIV.
In cases where initial therapy does not adequately control symptoms, adjunctive immunomodulating treatment may be considered. The complete protocol specifies the agents involved, supporting evidence, and the conditions under which escalation is appropriate.
DOI: 10.1016/S1473-3099(25)00364-0
For children and adolescents aged 19 years or younger with drug-susceptible tuberculous meningitis, WHO recently recommended that a 6-month regimen (isoniazid 15–20 mg/kg per day, rifampicin 22·5–30 mg/kg per day, and pyrazinamide 35–45 mg/kg per day, and the substitution of ethambutol with ethionamide at 17·5–22·5 mg/kg per day) can be used instead of the 12-month standard regimen.
High certainty of evidence, weak recommendation for use in people living with HIV so the decision to use should be made on a case-by-case basis.
If corticosteroids do not control symptoms, then small case-series and case reports have described the use of anti-TNF biologicals (eg, infliximab), thalidomide, or anakinra.
A retrospective cohort study in India reported adjunctive infliximab (10 mg/kg for one to three doses, 4 weeks apart) was safe and effective in treating severe inflammatory complications of tuberculous meningitis.
Observational studies in South African children have suggested that adjunctive thalidomide (2–5 mg/kg per day) was safe and effective in treating tuberculous mass lesions and optochiasmatic arachnoiditis.
View source ↗