Tuberculous pericarditis is associated with high mortality in parts of Africa and Asia, particularly in patients with concomitant HIV infection. Therefore, the IMPI trial (n = 1,400) was designed to determine whether the addition of either prednisolone (6 weeks) or Mycobacterium indicus pranii immunotherapy (3 months) to standard antituberculosis therapy improved outcomes. The results, presented at the ESC Congress 2014, show that neither adjunctive therapy had a significant effect on the primary composite outcome of death, cardiac tamponade requiring pericardiocentesis, and constrictive pericarditis. Conversely, both treatments were associated with an increased incidence of cancer, particularly HIV-related cancer.