TB meningitis in HIV-positive patients in Europe and Argentina: clinical outcome and factors associated with mortality

Biomed Res Int. 2013:2013:373601. doi: 10.1155/2013/373601. Epub 2013 Dec 31.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Argentinien
  • CD4 Lymphocyte Count
  • Europa
  • Female
  • HIV / isolation & purification
  • HIV / pathogenicity
  • HIV Infections / complications
  • HIV Infections / mortality
  • HIV Infections / pathology*
  • HIV Infections / therapy*
  • HIV Infections / virology
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Risk Factors
  • Treatment Outcome
  • Tuberculosis, Meningeal / complications
  • Tuberculosis, Meningeal / mortality
  • Tuberculosis, Meningeal / pathology*
  • Tuberculosis, Meningeal / therapy*
  • Tuberculosis, Meningeal / virology