Placebo-controlled trial of prednisone in advanced HIV-1 infection [McComsey GA, et al. AIDS 2001;15:321]: The authors present the first randomized, double-blind, placebo-controlled trial of prednisone (0.5 mg/kg/day) versus placebo in 41 patients with advanced HIV infection. At baseline, the median CD4 cell count was 131/mm³, and 85% had a history of opportunistic infections. The median duration of prednisone therapy was 158 days. Comparison of the two groups showed no difference in outcome in terms of CD4 count, viral load, or frequency of opportunistic infections. The authors conclude that prednisone was well tolerated and safe in patients with advanced HIV disease.
Comment: One of the reasons to do this study was the suggestion that immune activation may influence HIV replication, decrease CD4 cell count, and cause clinical deterioration. The logical extension of this hypothesis is that suppression of cellular activation with steroids could improve viral load, CD4 count, and clinical outcome. This study failed to show benefit from prednisone treatment, but did seem to provide assurance that corticosteroids can be given safely to patients with advanced HIV disease. Nevertheless, caution is needed because others have periodically reported adverse outcomes that presumably reflect the fact that both steroids and HIV infection appear to compromise cell-mediated immunity.
posted 3/20/2001

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