Immunoadjuvant prednisolone therapy for HIV-associated tuberculosis: a phase 2 clinical trial in Uganda
- PMID:15717259
- PMCID:PMC4515766
- DOI:10.1086/427995
Immunoadjuvant prednisolone therapy for HIV-associated tuberculosis: a phase 2 clinical trial in Uganda
摘要
Background. Human immunodeficiency virus (HIV)-infected patients with tuberculosis (TB) respond to effective antituberculous therapy, but their prognosis remains poor. Mounting evidence from clinical studies supports the concept of copathogenesis in which immune activation that is triggered by TB and mediated by cytokines stimulates viral replication and worsens HIV infection, especially when immune function is preserved.Methods. We performed a phase 2, randomized, double-blind, placebo-controlled clinical trial in Kampala, Uganda, to determine whether immunoadjuvant prednisolone therapy in HIV-infected patients with TB who have CD4(+) T cell counts >/=200 cells/ mu L is safe and effective at increasing CD4(+) T cell counts.Results. Short-term prednisolone therapy reduced levels of immune activation and tended to produce higher CD4(+) T cell counts. Although prednisolone therapy was associated with a more rapid clearance of Mycobacterium tuberculosis from the sputum, it was also associated with a transient increase in HIV RNA levels, which receded when prednisolone therapy was discontinued. The intervention worsened underlying hypertension and caused fluid retention and hyperglycemia.Conclusion. The benefits of prednisolone therapy on immune activation and CD4(+) T cell counts do not outweigh the risks of adverse events in HIV-infected patients with TB and preserved immune function.
Figures
Similar articles
-
A randomized, double-blind, placebo-controlled trial of the use of prednisolone as an adjunct to treatment in HIV-1-associated pleural tuberculosis.J感染说. 2004 Sep 1;190(5):869-78. doi: 10.1086/422257. Epub 2004 Jul 29. J感染说. 2004. PMID:15295690 Clinical Trial.
-
Clinical course of human immunodeficiency virus type 1 associated pulmonary tuberculosis during short-course antituberculosis therapy.东地中海误判率j . 1997 Sep;74(9):543-8. 东地中海误判率j . 1997. PMID:9487427 Clinical Trial.
-
A randomized trial of punctuated antiretroviral therapy in Ugandan HIV-seropositive adults with pulmonary tuberculosis and CD4⁺ T-cell counts of ≥ 350 cells/μL.J感染说. 2011 Sep 15;204(6):884-92. doi: 10.1093/infdis/jir503. J感染说. 2011. PMID:21849285 Free PMC article. Clinical Trial.
-
Therapeutic response of HIV-1 subtype C in African patients coinfected with either Mycobacterium tuberculosis or human herpesvirus-8.J感染说. 2005 Feb 1;191(3):324-32. doi: 10.1086/427337. Epub 2004 Dec 22. J感染说. 2005. PMID:15633090
-
Virological and immunological impact of tuberculosis on human immunodeficiency virus type 1 disease.J感染说. 2003 Oct 15;188(8):1146-55. doi: 10.1086/378676. Epub 2003 Sep 30. J感染说. 2003. PMID:14551885 Review.
Cited by50articles
-
Review of the Effectiveness of Various Adjuvant Therapies in TreatingMycobacterium tuberculosis.Infect Dis Rep. 2021 Sep 6;13(3):821-834. doi: 10.3390/idr13030074. Infect Dis Rep. 2021. PMID:34562999 Free PMC article. Review.
-
Elevated cerebrospinal fluid cytokine levels in tuberculous meningitis predict survival in response to dexamethasone.Proc Natl Acad Sci U S A. 2021 Mar 9;118(10):e2024852118. doi: 10.1073/pnas.2024852118. Proc Natl Acad Sci U S A. 2021. PMID:33658385 Free PMC article.
-
The effects of anti-inflammatory agents as host-directed adjunct treatment of tuberculosis in humans: a systematic review and meta-analysis.Respir Res. 2020 Aug 26;21(1):223. doi: 10.1186/s12931-020-01488-9. Respir Res. 2020. PMID:32847532 Free PMC article.
-
The effect of HIV-associated tuberculosis, tuberculosis-IRIS and prednisone on lung function.Eur Respir J. 2020 Mar 12;55(3):1901692. doi: 10.1183/13993003.01692-2019. Print 2020 Mar. Eur Respir J. 2020. PMID:31862762 Free PMC article.
-
Therapeutic host-directed strategies to improve outcome in tuberculosis.Mucosal Immunol. 2020 Mar;13(2):190-204. doi: 10.1038/s41385-019-0226-5. Epub 2019 Nov 26. Mucosal Immunol. 2020. PMID:31772320 Free PMC article. Review.
Publication types
MeSH terms
Substances
Grant support
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials