title: Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures.
abstract: OBJECT Hydrocephalus is one of the commonest complications of tubercular meningitis (TBM), and its incidence is increasing with the HIV epidemic. Literature evaluating the role of ventriculoperitoneal shunts in HIV-positive patients with TBM and their long-term prognosis is scarce. METHODS Between June 2002 and October 2012, 30 HIV-positive patients with TBM and hydrocephalus underwent ventriculoperitoneal shunt placement. Thirty age-, sex-, and grade-matched HIV-negative patients with TBM and hydrocephalus were randomly selected as the control group. Outcome was analyzed at discharge (short-term outcome) and at follow-up (long-term outcome). Univariate and multivariate analyses were performed to look for predictors of outcome; p < 0.05 was considered significant. RESULTS There were no differences in the clinical, radiological, or biochemical parameters between the 2 groups. Short-term outcome was better in the HIV-negative group (76.7% improvement) than in the HIV-positive group (70%). However, the long-term outcome in HIV-positive patients was very poor (66.7% mortality and 76.2% poor outcome) compared with HIV-negative patients (30.8% mortality and 34.6% poor outcome). Seropositivity for HIV is an independent predictor of poor outcome both in univariate and multivariate analyses (p = 0.038). However, in contrast to previous reports, of 5 patients with TBM in good Palur grades among the HIV-positive patients, 4 (80%) had good outcome following shunt placement. CONCLUSIONS The authors recommend that shunt treatment should not be performed in HIV-positive patients in poor Palur grade with hydrocephalus. A trial of external ventricular drainage should be undertaken in such patients, and shunt treatment should be performed only if there is any improvement. However, HIV-positive patients in good Palur grades should undergo VP shunt placement, as these patients have better outcomes than previously reported.
authors: Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
authors: Raman Mohan
authors: RM
authors: Sharma
authors: Nupur
authors: N
authors: Pruthi
authors: Arivazhagan
authors: A
authors: Arimappamagan
authors: Sampath
authors: S
authors: Somanna
authors: Bhagavathula Indira
authors: BI
authors: Devi
authors: Paritosh
authors: P
authors: Pandey
mesh_terms: D000293:Adolescent; D000328:Adult; D004322:Drainage; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult
keywords: GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; HIV; TBM = tubercular meningitis; VP = ventriculoperitoneal; hydrocephalus; shunt; tubercular meningitis