9.3 Adjunctive corticosteroid therapy

Corticosteroids are indicated for:
– Meningitis of all stages of severity;
– Effusions: pleural effusion with severe respiratory difficulties; pericardial effusion;
– Compressions: laryngitis with obstruction of upper airways; urinary tract TB (in order to prevent ureteric stenosis); lymph node hypertrophy with bronchial or arterial compression;
– Severe hypersensitivity to TB drugs (although effectiveness has not been demonstrated);
– Life-threatening paradoxical reactions (immune reconstitution inflammatory syndrome) at the beginning of antiretroviral therapy or TB treatment (Chapter 12, Section 12.7)1 .

The suggested treatment is prednisolone PO (or prednisone) for 6 to 12 weeks according to the severity of symptoms and clinical response:
– Children: 2 mg/kg once daily in the morning, up to 4 mg/kg once daily in severely ill children (max. 60 mg once daily)
– Adults: 40 to 60 mg once daily in the morning

The dose should be tapered off in the last 2 weeks. For adults, decrease the dose by 5-10 mg every 2 to 3 days. Stopping the corticosteroids abruptly may result in adrenal crisis.

Ref Notes

Though corticosteroids are immunosuppressive, they may still be used safely in many HIV patients, depending on the immune status and concurrent infections. Never start corticosteroid treatment before anti-TB therapy.