TB Meningitis in HIV-Positive Patients in Europe and Argentina: Clinical Outcome and Factors Associated with Mortality

• Published in: BioMed research international Vol. 2013; pp. 373601 - 9
• Main Authors: Efsen, Anne Marie W., Panteleev, Alexander M., Grint, Daniel, Podlekareva, Daria N., Vassilenko, Anna, Rakhmanova, Aza, Zeltina, Indra, Losso, Marcelo H., Miller, Robert F., Girardi, Enrico, Caylá, Joan, Post, Frank A., Miro, Jose M., Bruyand, Mathias, Furrer, Hansjakob, Obel, Niels, Lundgren, Jens D., Mocroft, Amanda, Kirk, Ole, Study Group, HIV/TB
• Format: Journal Article
• Language: English
• Published: United States Hindawi Publishing Corporation 01.01.2013; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Argentina; CD4 Lymphocyte Count; Colleges & universities; Drug therapy; Europe; Female; HIV; HIV - isolation & purification; HIV - pathogenicity; HIV Infections - complications; HIV Infections - mortality; HIV Infections - pathology; HIV Infections - therapy; HIV Infections - virology; HIV patients; Hospitals; Human immunodeficiency virus; Humans; Kaplan-Meier Estimate; Male; Medical research; Medicine, Experimental; Meningitis; Mortality; Patient outcomes; Risk Factors; Treatment Outcome; Tuberculosis; Tuberculosis, Meningeal - complications; Tuberculosis, Meningeal - mortality; Tuberculosis, Meningeal - pathology; Tuberculosis, Meningeal - therapy; Tuberculosis, Meningeal - virology; Argentina; Europe; Latvia
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2013/373601

Objectives. The study aimed at describing characteristics and outcome of tuberculous meningitis (TBM) in HIV-positive patients and comparing these parameters with those of extrapulmonary TB (TBEP) and pulmonary TB (TBP). Methods. Kaplan-Meier estimation and Poisson regression models were used to assess the mortality following TB diagnosis and to evaluate potential prognostic factors for the 3 groups of TB patients separately. Results. A total of 100 patients with TBM, 601 with TBEP, and 371 TBP were included. Patients with TBM had lower CD4 cell counts and only 17.0% received antiretroviral therapy (ART) at TB diagnosis. The cumulative probability of death at 12 months following TB was 51.2% for TBM (95% CI 41.4–61.6%), 12.3% for TBP (8.9–15.7%), and 19.4% for TBEP (16.1–22.6) (P<0.0001; log-rank test). For TBM, factors associated with a poorer prognosis were not being on ART (adjusted incidence rate ratio (aIRR) 4.00 (1.72–9.09), a prior AIDS diagnosis (aIRR=4.82 (2.61–8.92)), and receiving care in Eastern Europe (aIRR=5.41 (2.58–11.34))). Conclusions. TBM among HIV-positive patients was associated with a high mortality rate, especially for patients from Eastern Europe and patients with advanced HIV-infection, which urgently calls for public health interventions to improve both TB and HIV aspects of patient management.