Efficacy and safety of adjuvant glucocorticoid therapy for Pneumocystis pneumonia (PCP) in patients positive for HIV: a systematic review and meta-analysis

Objective To systematically evaluate the efficacy and safety of glucocorticoids as adjuvant therapy for Pneumocystis pneumonia (PCP) in patients positive for human immunodeficiency virus (HIV). Methods Clinical randomized controlled trials or clinical controlled trials evaluating the efficacy and safety of glucocorticoids as adjuvant therapy for PCP in patients who are HIV-positive were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. Data extraction and methodological quality assessment were performed for eligible studies. Meta-analysis and systematic evaluation were conducted using RevMan v.5.1 and STATA v.12.0 software. Results Nine articles (13 studies) were included. Compared with the controls, patients treated with glucocorticoids had significantly lower mortality rates (OR = 0.41, 95% CI [0.28–0.59], P < 0.00001), early deterioration rates (OR = 0.08, 95% CI [0.02–0.39], P = 0.002), and lower mechanical ventilation rates (OR = 0.32, 95% CI [0.19–0.55], P < 0.0001). Regarding safety, the incidence of adverse effects did not differ significantly between the two groups (OR = 0.74, 95% CI [0.33–1.70], P = 0.48). Conclusion Adjuvant glucocorticoid therapy significantly reduces mortality, early deterioration, and mechanical ventilation rates in patients who are HIV-positive with PCP without increasing adverse reactions. Glucocorticoids may serve as a viable adjuvant treatment option for PCP in patients who are HIV-positive. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/home , identifier CRD420261418795.