title: Bacterial meningitis in HIV-1-infected patients in the era of highly active antiretroviral therapy.
abstract: BACKGROUND
  The burden that spontaneous bacterial meningitis (SBM) currently represents among HIV-1-infected patients is poorly known.
  
  
  METHODS
  We prospectively evaluated 32 episodes of SBM in HIV-1-infected patients from the VACH (VIH-Aplicación de Control Hospitalario) Cohort and compared findings with those of 267 episodes in uninfected persons, matched by age and year of infection. A group of 13,187 HIV-1-infected patients from the VACH Cohort were used to identify predictors for acquiring SBM.
  
  
  RESULTS
  Between 1997 and 2006, we found 32 episodes of SBM among HIV-1-infected patients for an annual incidence rate of 62.0 cases per 100,000 population compared with 3.2 (3.0 to 3.4) per 100,000 population for uninfected patients (P < 0.001). The last CD4 >or=200/mm count was the only predictor for developing SBM. Compared with uninfected, HIV-1-infected patients with SBM had a greater prevalence of primary extrameningeal infection, especially pneumonia (P = 0.02), bacteremia (P = 0.02), focal neurologic signs (P = 0.005), seizures (P = 0.06), a lower cerebrospinal fluid to blood glucose ratio (P = 0.02), and a lower prevalence of nuchal rigidity (P = 0.005). Streptococcus pneumoniae was the most frequent etiologic agent among HIV-1-infected patients. HIV-1-infected patients had neurologic complications more frequently (P = 0.02), a higher overall case fatality rate (P = 0.004), and greater incidence of neurologic sequelae (P = 0.001).
  
  
  CONCLUSIONS
  Even in the highly active antiretroviral therapy era, the risk of developing SBM is 19 times higher among HIV-1-infected patients than among uninfected ones. It tends to present in severely immunosuppressed patients not previously vaccinated and off antiretroviral therapy, with a concomitant extrameningeal infection, bacteremia, and focal neurologic signs, and is caused by S. pneumoniae. SBM in HIV-1-infected patients carries a worse prognosis than in uninfected ones both in terms of lethality and sequelae.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. pdomingo@santpau.es
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.forename: Ignacio
authors.initials: I
authors.lastname: Suarez-Lozano
authors.forename: Ferran
authors.initials: F
authors.lastname: Torres
authors.forename: Virginia
authors.initials: V
authors.lastname: Pomar
authors.forename: Esteban
authors.initials: E
authors.lastname: Ribera
authors.forename: Ma Jose
authors.initials: MJ
authors.lastname: Galindo
authors.forename: Jaime
authors.initials: J
authors.lastname: Cosin
authors.forename: Ma Luisa
authors.initials: ML
authors.lastname: Garcia-Alcalde
authors.forename: Francesc
authors.initials: F
authors.lastname: Vidal
authors.forename: Jose
authors.initials: J
authors.lastname: Lopez-Aldeguer
authors.forename: Bernardino
authors.initials: B
authors.lastname: Roca
authors.forename: Juan
authors.initials: J
authors.lastname: Gonzalez
authors.forename: Fernando
authors.initials: F
authors.lastname: Lozano
authors.forename: Myriam
authors.initials: M
authors.lastname: Garrido
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications*; D008584:Meningitis, Listeria / Q000150:complications; D008585:Meningitis, Meningococcal / Q000150:complications; D008586:Meningitis, Pneumococcal / Q000150:complications; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D055815:Young Adult