Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults

To the Editor: Donovan et al. (Oct. 12 issue)(1) found that the use of adjunctive glucocorticoids was not associated with a significant reduction in death among persons with human immunodeficiency virus (HIV)-associated tuberculous meningitis (hazard ratio vs. placebo, 0.85; 95% confidence interval [CI], 0.66 to 1.10; P=0.22). We previously reported that acellular cerebrospinal fluid (CSF) is common in persons with HIV-associated tuberculous meningitis(2) and that a CSF white-cell count of less than 5 per microliter is associated with a risk of death that is four times as great as that with a white-cell count of more than 100 per microliter . . .