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. 2013:2013:373601.
doi: 10.1155/2013/373601. Epub 2013 Dec 31.

TB meningitis in HIV-positive patients in Europe and Argentina: clinical outcome and factors associated with mortality

Anne Marie W Efsen  1 , Alexander M Panteleev  2 , Daniel Grint  3 , Daria N Podlekareva  1 , Anna Vassilenko  4 , Aza Rakhmanova  5 , Indra Zeltina  6 , Marcelo H Losso  7 , Robert F Miller  8 , Enrico Girardi  9 , Joan Caylá  10 , Frank A Post  11 , Jose M Miro  12 , Mathias Bruyand  13 , Hansjakob Furrer  14 , Niels Obel  15 , Jens D Lundgren  16 , Amanda Mocroft  3 , Ole Kirk  16 ; HIV/TB Study Group
Collaborators, Affiliations

TB meningitis in HIV-positive patients in Europe and Argentina: clinical outcome and factors associated with mortality

Anne Marie W Efsen et al. Biomed Res Int. 2013.

Abstract

Objectives: 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.

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Figures

Figure 1
Figure 1
Outcomes following TB diagnosis.
Figure 2
Figure 2
Kaplan-Meier progression to death.
See this image and copyright information in PMC

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