The influence of HIV infection on clinical presentation, response to treatment, and outcome in adults with Tuberculous meningitis.
BACKGROUND
Tuberculous meningitis occurs more commonly in human immunodeficiency virus (HIV)-infected individuals than in HIV-uninfected individuals, but whether HIV infection alters the presentation and outcome of tuberculous meningitis is unknown.


METHODS
We performed a prospective comparison of the presenting clinical features and response to treatment in 528 adults treated consecutively for tuberculous meningitis (96 were infected with HIV and 432 were uninfected with HIV) in 2 tertiary-care referral hospitals in Ho Chi Minh City, Vietnam. Logistic regression was used to model variables associated independently with HIV infection, 9-month survival, and the likelihood of having a relapse or an adverse drug event. Kaplan-Meier estimates were used to compare survival rates and times to fever clearance, coma clearance, relapse, and adverse events.


RESULTS
HIV infection did not alter the neurological presentation of tuberculous meningitis, although additional extrapulmonary tuberculosis was more likely to occur in HIV-infected patients. The 9-month survival rate was significantly decreased in HIV-infected patients (relative risk of death from any cause, 2.91 [95% confidence interval, 2.14-3.96]; P < .001), although the times to fever clearance and coma clearance and the number or timing of relapses or adverse drug events were not significantly different between the groups.


CONCLUSIONS
HIV infection does not alter the neurological features of tuberculous meningitis but significantly reduces the survival rate.
Thwaites
Guy E
GE
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. guy.thwaites@btinternet.com
Duc Bang
Nguyen
N
Huy Dung
Nguyen
N
Thi Quy
Hoang
H
Thi Tuong Oanh
Do
D
Thi Cam Thoa
Nguyen
N
Quang Hien
Nguyen
N
Tri Thuc
Nguyen
N
Ngoc Hai
Nguyen
N
Thi Ngoc Lan
Nguyen
N
Ngoc Lan
Nguyen
N
Hong Duc
Nguyen
N
Ngoc Tuan
Vu
V
Huu Hiep
Cao
C
Thi Hong Chau
Tran
T
Phuong Mai
Pham
P
Thi Dung
Nguyen
N
Stepniewska
Kasia
K
Simmons
Cameron P
CP
White
Nicholas J
NJ
Tinh Hien
Tran
T
Farrar
Jeremy J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D003128:Coma; D005260:Female; D005334:Fever; D015658:HIV Infections / Q000150:complications*; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000188:drug therapy* / Q000503:physiopathology*; D014744:Vietnam
D000900:Anti-Bacterial Agents