期刊
EXPERT REVIEW OF RESPIRATORY MEDICINE
卷 12, 期 10, 页码 881-891出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/17476348.2018.1515628
关键词
Tuberculosis; corticosteroid; drug therapy; tuberculous meningitis; tuberculous pericarditis
资金
- Francis Crick Institute via Cancer Research UK [FC00101218]
- United Kingdom Medical Research Council [FC00110218, MR/R008922/1]
- Wellcome [FC00110218, 104803, 203135]
- European and Developing Countries Clinical Trials Partnership [SRIA2015-1065]
- Foundation for the National Institutes of Health [WILKI16PTB]
- U.S. Department of Health and Human Services
- National Institute of Allergy and Infectious Diseases [U01AI115940]
- South African Medical Research Council [National Health Scholarship Programme]
- National Research Foundation of South Africa [IFR150414117178, 96841]
- National Institutes of Health
- MRC [MC_U117588499, MR/R008922/1] Funding Source: UKRI
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [U01AI115940] Funding Source: NIH RePORTER
Introduction: Inflammation, or the prolonged resolution of inflammation, contributes to death from tuberculosis. Interest in inflammatory mechanisms and the prospect of beneficial immune modulation as an adjunct to antibacterial therapy has revived and the concept of host directed therapies has been advanced. Such renewed attention has however, overlooked the experience of such therapy with corticosteroids.Areas covered: The authors conducted literature searches and evaluated randomized clinical trials, systematic reviews and current guidelines and summarize these findings. They found evidence of benefit in meningeal and pericardial tuberculosis in HIV-1 uninfected persons, but less so in those HIV-1 coinfected and evidence of harm in the form of opportunist malignancy in those not prescribed antiretroviral therapy. Adjunctive corticosteroids are however of benefit in the treatment and prevention of paradoxical HIV-tuberculosis immune reconstitution inflammatory syndrome.Expert commentary: Further high-quality clinical trials and experimental medicine studies are warranted and analysis of materials arising from such studies could illuminate ways to improve corticosteroid efficacy or identify novel pathways for more specific intervention.
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