What can be done about effusive tuberculous pericarditis in HIV-seropositive patients?

The early effusive stage of tuberculous pericarditis (TBP) is life-threatening despite early intervention with antituberculous treatment (ATT). Data from interventional studies in Africa support the use of adjunctive corticosteroids in human immunodeficiency virus (HIV) and non-HlV populations; their use, however, remains controversial. Rapid identification and treatment of TBP is needed in order to minimize the impact of tamponade in the early effusive stage and subsequent constriction. Where resources are available, diagnosis requires echocardiographic confirmation of the effusion, pericardiocentesis for microbiological confirmation, and trimodal treatment including ATT, antiretroviral therapy (ART), and adjunctive corticosteroids. There is no evidence for prolonging the course of ATT beyond the standard 6 months. ART should start early for those with advanced HIV, but be deferred for those with CD4 T cell counts >200 cells/mm 3 .