title: The effect of HIV infection on adult meningitis in Indonesia: a prospective cohort study.
abstract: OBJECTIVE
  Indonesia has a concentrated but rapidly growing HIV epidemic. We examined the effect of HIV on causative organisms, clinical features and prognosis of adult meningitis.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  All adult patients at a referral hospital who underwent cerebrospinal fluid examination for suspected meningitis were examined for HIV and included in a prospective cohort study. Microbiological testing was done for common bacterial pathogens, mycobacteria and fungi. Patients were followed for at least 6 months, and logistic regression models were used to identify risk factors for mortality.
  
  
  RESULTS
  Among 185 patients who mostly presented with subacute meningitis, 60% were male and the median age was 30 years. HIV infection was present in 25% of the patients; almost two-thirds were newly confirmed, and all presented with severe immunosuppression (median CD4 cell count 13/microl, range 2-98). One-third of HIV-infected patients had cryptococcal meningitis whereas two-thirds suffered from tuberculosis. After 1 month, 41% of patients had died. HIV infection was strongly associated with 1-month mortality (adjusted odds ratio 12.15; 95% confidence interval 3.04-15.72) and death during extended follow-up (hazard ratio 2.48; 95% confidence interval 1.97-5.74).
  
  
  CONCLUSIONS
  Although HIV is still uncommon in the general population in Indonesia, its prevalence among adult meningitis cases already seems high. Mycobacterium tuberculosis and Cryptococcus neoformans are the main causes of meningitis in this setting, and mortality is very high, especially in HIV-infected patients. Our data suggest that adult meningitis cases in Indonesia should be screened routinely for HIV infection. Further studies are needed to address the high mortality.
authors.affiliation: Department of Neurology, Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung 40161, Indonesia. rizalbdg@gmail.com
authors.forename: A Rizal
authors.initials: AR
authors.lastname: Ganiem
authors.forename: Ida
authors.initials: I
authors.lastname: Parwati
authors.forename: Rudi
authors.initials: R
authors.lastname: Wisaksana
authors.forename: Adri
authors.initials: A
authors.lastname: van der Zanden
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.forename: Patrick
authors.initials: P
authors.lastname: Sturm
authors.forename: Andre
authors.initials: A
authors.lastname: van der Ven
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Brouwer
authors.forename: Nani
authors.initials: N
authors.lastname: Kurniani
authors.forename: Jan
authors.initials: J
authors.lastname: de Gans
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology; D000328:Adult; D018791:CD4 Lymphocyte Count; D003455:Cryptococcus neoformans; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D016921:Meningitis, Fungal / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D014390:Tuberculosis, Meningeal / Q000196:embryology* / Q000382:microbiology