Background

Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Co-infection with HIV increases the risk of developing TBM, complicates treatment, and substantially worsens outcomes. Whether corticosteroids confer a survival benefit in HIV-infected patients with TBM remains uncertain.

Aims

Our primary aim is to determine whether dexamethasone is a safe and effective addition to the first 6–8 weeks of anti-tuberculosis treatment of TBM in patients with HIV in terms of:

• Improving survival;
• Lengthening the time to new neurological events, IRIS, drug-related adverse events, opportunistic infections, and disability;
• Longer-term neurological outcomes;
• Reducing HIV-associated malignancy.

Our secondary aim is to investigate alternative management strategies in a subset of patients who develop drug-induced liver injury (DILI), which will enable the safe continuation of rifampicin and isoniazid therapy whenever possible.