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

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 ass...

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Published inBioMed 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
LanguageEnglish
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
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Abstract 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.
AbstractList OBJECTIVESThe 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).METHODSKaplan-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.RESULTSA 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))).CONCLUSIONSTBM 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.
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.
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.
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). 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. 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))). 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.
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.
Audience Academic
Author Study Group, HIV/TB
Losso, Marcelo H.
Miro, Jose M.
Mocroft, Amanda
Furrer, Hansjakob
Grint, Daniel
Zeltina, Indra
Vassilenko, Anna
Efsen, Anne Marie W.
Caylá, Joan
Lundgren, Jens D.
Miller, Robert F.
Rakhmanova, Aza
Girardi, Enrico
Post, Frank A.
Panteleev, Alexander M.
Obel, Niels
Kirk, Ole
Podlekareva, Daria N.
Bruyand, Mathias
AuthorAffiliation 10 Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), 08 036 Barcelona, Spain
2 TB Hospital No. 2, Russian Federation, 195267 Saint Petersburg, Russia
8 Centre for Sexual Health & HIV Research, Mortimer Market Centre, University College London, London WC1E 6JB, UK
6 Infectology Centre of Latvia, 1006 Riga, Latvia
16 Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, 2100 Copenhagen, Denmark
4 Belorusian State Medical University, Minsk 220002, Belarus
5 St. Petersburg AIDS Centre, 193167 Saint Petersburg, Russia
13 Centre Hospitalier Universitaire (CHU) de Bordeaux, COREVIH Aquitaine, 33000 Bordeaux, France
15 Department of Infectious Diseases, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland
9 Istituto Nazionale Malattie Infettive L Spallanzani, 00149 Rome, Italy
7 Hospital JM Ramos Mejia, Servicio de Inmunocomprometidos, CP 1221 Buenos Aires, Argentina
14 INSERM, ISPED, Centre
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/24699884$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Contributor Bonnal, F
Karpov, I
Suetnov, O
Titier, K
Cazanave, C
Gerstoft, J
Zhavoronok, S
David, D
Jensen, J
Neau, D
Dupont, A
Vareil, M O
Viallard, J F
Ortiz, M Cristina
Paduto, D
Gerard, Y
Bondarenko, V
Caunègre, L
Larsen, C S
Hualde, M
Miachans, M
Skrahina, E
Obel, N
Kronborg, G
Pederson, C
Greib, C
Chêne, G
Lafon, M E
Skrahin, A
Trimoulet, P
Contarelli, J
Dauchy, F A
Ceccaldi, J
Moreau, J F
Mercié, P
Tamayo, N
Vassilenko, A
Longy-Boursier, M
Schmeltz, J Roger
Bruguera, J M
Duffau, P
Ochoa, A
André, K
Vandenhende, M A
Farbos, S
Reigadas, S
Malvy, D
Casiró, A
Hessamfar, M
Murano, F
Losso, Marcelo H
Metta, H
Gemain, M C
Cuini, R
Lazaro, E
Bouchet, S
Lupo, S
Lawson-Ayayi, S
Pellegrin, I
Marson, C
Corti, M
Receveur, M C
Garcia Messina, O
Ruzanov, D
Laplume, H
Mitsura, V
Bruyand, M
Pistone, T
Haramburu, F
Scapelatto, P
Laursen, A L
Toibaro, J J
Warley, E
De Witte, S
Bottaro, E
Nielsen, L
Pellegrin, J L
Morlat, P
Bonnet, F
Tchamgoué, S
Pedersen, G
Bernard, N
Corral, J
Arcachon, G
Miglioranza, C
Lacoste, D
Dabis, F
Breihl, D
Dutronc, H
Trape, L
Molimard, M
Dupon, M
Gear, O
Wittkop, L
Fleury,
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Copyright Copyright © 2013 Anne Marie W. Efsen et al.
COPYRIGHT 2014 John Wiley & Sons, Inc.
Copyright © 2013 Anne Marie W. Efsen et al. Anne Marie W. Efsen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright © 2013 Anne Marie W. Efsen et al. 2013
Copyright_xml – notice: Copyright © 2013 Anne Marie W. Efsen et al.
– notice: COPYRIGHT 2014 John Wiley & Sons, Inc.
– notice: Copyright © 2013 Anne Marie W. Efsen et al. Anne Marie W. Efsen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Snippet Objectives. The study aimed at describing characteristics and outcome of tuberculous meningitis (TBM) in HIV-positive patients and comparing these parameters...
The study aimed at describing characteristics and outcome of tuberculous meningitis (TBM) in HIV-positive patients and comparing these parameters with those of...
Objectives. The study aimed at describing characteristics and outcome of tuberculous meningitis (TBM) in HIV-positive patients and comparing these parameters...
OBJECTIVESThe study aimed at describing characteristics and outcome of tuberculous meningitis (TBM) in HIV-positive patients and comparing these parameters...
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SubjectTerms 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
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Title TB Meningitis in HIV-Positive Patients in Europe and Argentina: Clinical Outcome and Factors Associated with Mortality
URI https://dx.doi.org/10.1155/2013/373601
https://www.ncbi.nlm.nih.gov/pubmed/24699884
https://www.proquest.com/docview/1503489723
https://search.proquest.com/docview/1508761148
https://www.proquest.com/docview/1513050686
https://pubmed.ncbi.nlm.nih.gov/PMC3930027
Volume 2013
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