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Review
. 2023 Dec;20(6):379-393.
doi: 10.1007/s11904-023-00678-6. Epub 2023 Nov 10.

Advancing Diagnosis and Treatment in People Living with HIV and Tuberculosis Meningitis

Sarah Kimuda  1 , Derrick Kasozi  1 , Suzan Namombwe  1 , Jane Gakuru  1 , Timothy Mugabi  1 , Enock Kagimu  1 , Morris K Rutakingirwa  1 , Kristoffer E Leon  2 , Felicia Chow  2 , Sean Wasserman  3   4 , David R Boulware  5 , Fiona V Cresswell  1   6   7 , Nathan C Bahr  8
Affiliations
Review

Advancing Diagnosis and Treatment in People Living with HIV and Tuberculosis Meningitis

Sarah Kimuda et al. Curr HIV/AIDS Rep. 2023 Dec.

Abstract

Purpose of review: Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Inadequate diagnostic testing and treatment regimens adapted from pulmonary tuberculosis without consideration of the unique nature of TBM are among the potential drivers. This review focuses on the progress being made in relation to both diagnosis and treatment of TBM, emphasizing promising future directions.

Recent findings: The molecular assay GeneXpert MTB/Rif Ultra has improved sensitivity but has inadequate negative predictive value to "rule-out" TBM. Evaluations of tests focused on the host response and bacterial components are ongoing. Clinical trials are in progress to explore the roles of rifampin, fluoroquinolones, linezolid, and adjunctive aspirin. Though diagnosis has improved, novel modalities are being explored to improve the rapid diagnosis of TBM. Multiple ongoing clinical trials may change current therapies for TBM in the near future.

Keywords: Central nervous system infection; Diagnostic tests; TB; Tuberculosis; Tuberculous meningitis.

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Conflict of interest statement

Dr. Bahr declares grant funding from the NIH. Dr. Bahr also declares that his institution received funds for his role as a PI in an unrelated trial from Karyopharm Therapeutics. Dr. Boulware declares grant funding from NIH. Dr. Chow, Dr. Gakuru, Dr. Cresswell, Dr. Wasserman, Dr. Kagimu, Dr. Kasozi, Dr. Kumuda, Mr. Leon, Dr. Mugabi, Dr. Maombwe, and Dr. Rutakingirwa declare no conflict of interest.

Figures

Fig. 1
Fig. 1
TBM uniform case definition
See this image and copyright information in PMC

References

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