Adding Streptomycin to an Intensified Regimen for Tuberculous Meningitis Improves Survival in HIV-Infected Patients.
In low- and middle-income countries, the mortality of HIV-associated tuberculous meningitis (TM) continues to be unacceptably high. In this observational study of 228 HIV-infected patients with TM, we compared the mortality during the first nine months of patients treated with standard antituberculosis therapy (sATT), intensified ATT (iATT), and iATT with streptomycin (iATT + STM). The iATT included levofloxacin, ethionamide, pyrazinamide, and double dosing of rifampicin and isoniazid and was given only during the hospital admission (median 7 days, interquartile range 6-9). No mortality differences were seen in patients receiving the sATT and the iATT. However, patients receiving the iATT + STM had significant lower mortality than those in the sATT group (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.24 to 0.93). After adjusting for other covariates, the mortality hazard of the iATT + STM versus the sATT remained statistically significant (adjusted HR 0.2, 95% CI 0.09 to 0.46). Other factors associated with mortality were previous ATT and low albumin concentrations. The mortality risk increased exponentially only with CD4+ lymphocyte concentrations below 100 cells/μL. In conclusion, the use of iATT resulted in a clinically important reduction in mortality compared with the standard of care only if associated with STM. The results of this study deserve further research.
Department of Infectious Diseases, Bathalapalli Rural Development Trust Hospital, Kadiri Road, Bathalapalli, Andhra Pradesh 515661, India.
Gerardo
G
Alvarez-Uria
Department of Infectious Diseases, Bathalapalli Rural Development Trust Hospital, Kadiri Road, Bathalapalli, Andhra Pradesh 515661, India.
Raghavakalyan
R
Pakam
Department of Infectious Diseases, Bathalapalli Rural Development Trust Hospital, Kadiri Road, Bathalapalli, Andhra Pradesh 515661, India.
Manoranjan
M
Midde
Department of Infectious Diseases, Bathalapalli Rural Development Trust Hospital, Kadiri Road, Bathalapalli, Andhra Pradesh 515661, India.
Pradeep Sukumar
PS
Yalla
Department of Infectious Diseases, Bathalapalli Rural Development Trust Hospital, Kadiri Road, Bathalapalli, Andhra Pradesh 515661, India.
Praveen Kumar
PK
Naik