TB meningitis in HIV-positive patients in Europe and Argentina: clinical outcome and factors associated with mortality.
OBJECTIVE
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.
Copenhagen HIV Programme, Rigshospitalet, Faculty of Health and Medical Sciences, Copenhagen University Hospital and University of Copenhagen, 2200 Copenhagen N, Denmark.
Anne Marie W
AM
Efsen
TB Hospital No. 2, Russian Federation, 195267 Saint Petersburg, Russia.
Alexander M
AM
Panteleev
University College London, Royal Free Campus, London NW3 2PF, UK.
Daniel
D
Grint
Copenhagen HIV Programme, Rigshospitalet, Faculty of Health and Medical Sciences, Copenhagen University Hospital and University of Copenhagen, 2200 Copenhagen N, Denmark.
Daria N
DN
Podlekareva
Belorusian State Medical University, Minsk 220002, Belarus.
Anna
A
Vassilenko
St. Petersburg AIDS Centre, 193167 Saint Petersburg, Russia.
Aza
A
Rakhmanova
Infectology Centre of Latvia, 1006 Riga, Latvia.
Indra
I
Zeltina
Hospital JM Ramos Mejia, Servicio de Inmunocomprometidos, CP 1221 Buenos Aires, Argentina.
Marcelo H
MH
Losso
Centre for Sexual Health & HIV Research, Mortimer Market Centre, University College London, London WC1E 6JB, UK.
Robert F
RF
Miller
Istituto Nazionale Malattie Infettive L Spallanzani, 00149 Rome, Italy.
Enrico
0000-0001-8182-5896
E
Girardi
Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), 08 036 Barcelona, Spain.
Joan
J
Caylá
King's College London School of Medicine, London SE5 9RS, UK.
Frank A
FA
Post
Hospital Clinic-IDIBAPS, University of Barcelona, 08 036 Barcelona, Spain.
Jose M
JM
Miro
Centre Hospitalier Universitaire (CHU) de Bordeaux, COREVIH Aquitaine, 33000 Bordeaux, France ; INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France.
Mathias
M
Bruyand
Department of Infectious Diseases, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland.
Hansjakob
0000-0002-1375-3146
H
Furrer
Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, 2100 Copenhagen, Denmark.
Niels
0000-0002-5031-0045
N
Obel
Copenhagen HIV Programme, Rigshospitalet, Faculty of Health and Medical Sciences, Copenhagen University Hospital and University of Copenhagen, 2200 Copenhagen N, Denmark ; Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, 2100 Copenhagen, Denmark.
Jens D
JD
Lundgren
University College London, Royal Free Campus, London NW3 2PF, UK.
Amanda
A
Mocroft
Copenhagen HIV Programme, Rigshospitalet, Faculty of Health and Medical Sciences, Copenhagen University Hospital and University of Copenhagen, 2200 Copenhagen N, Denmark ; Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, 2100 Copenhagen, Denmark.
Ole
O
Kirk
D000328:Adult; D001118:Argentina; D018791:CD4 Lymphocyte Count; D005060:Europe; D005260:Female; D006678:HIV / Q000302:isolation & purification / Q000472:pathogenicity; D015658:HIV Infections / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy* / Q000821:virology