[Tuberculous meningitis: a comparative study in relation to concurrent human immunodeficiency virus infection].
BACKGROUND
This study assesses the epidemiological and clinical data, as well as therapy and evolution in a recent series of patients with tuberculous meningitis (MT). A comparative study was conducted between adult MT patients with and without concurrent human immunodeficiency virus (HIV) infection.


METHODS
From 1987 to 2000, 75 episodes of MT were diagnosed, 39 of them (52%) in patients with prior HIV infection. A comparative study was performed of variables related to the presence or absence of HIV and MT coinfection.


RESULTS
MT was more frequent in HIV patients (6.4% versus 1.2%, p < 0.01). CD41 lymphocyte value in HIV patients was 52 +/- 66 cells/mm3. There were no significant differences in clinical manifestations or cerebrospinal fluid biochemical alterations between the two groups. Extrameningeal TB was more frequent in patients with HIV coinfection than those without (61.5% vs. 36.1%, p = 0.03). Radiological alterations on cranial studies were more frequent in HIV-infected patients. Treatment with four antituberculosis drugs was also more frequent in HIV-infected patients (61.5% vs. 13.9%, p = 0.01). There were no differences in adverse effects between the groups. Overall mortality (20.5% vs. 22.51%) and neurological sequelae (7.7% vs. 5.6%) were also similar.


CONCLUSIONS
Half of our MT patients were coinfected with HIV. Their clinical, microbiological and evolutionary characteristics were comparable to those of patients without HIV infection. These results indicate that the diagnostic and therapeutic strategies applied in MT patients with or without HIV coinfection can be similar.
Azuaje
Carlos
C
Servicios de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. azuaje@sapo.pt
Fernández Hidalgo
Núria
N
Almirante
Benito
B
Martín-Casabona
Nuria
N
Ribera
Esteve
E
Díaz
Marjorie
M
Prats
Guillem
G
Pahissa
Albert
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000209:etiology; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D015897:Comorbidity; D003244:Consciousness Disorders / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000209:etiology; D015658:HIV Infections / Q000453:epidemiology*; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*
D000995:Antitubercular Agents