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

Anne Marie W Efsen, Alexander M Panteleev, Daniel Grint, Daria N Podlekareva, Anna Vassilenko, Aza Rakhmanova, Indra Zeltina, Marcelo H Losso, Robert F Miller, Enrico Girardi, Joan Caylá, Frank A Post, Jose M Miro, Mathias Bruyand, Hansjakob Furrer, Niels Obel, Jens D Lundgren, Amanda Mocroft, Ole Kirk, HIV/TB Study Group

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.

Figures

Figure 1
Figure 1
Outcomes following TB diagnosis.
Figure 2
Figure 2
Kaplan-Meier progression to death.

References

    1. Thwaites GE, Bang ND, Dung NH, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. The New England Journal of Medicine. 2004;351(17):1741–1751.
    1. Berenguer J, Moreno S, Laguna F, et al. Tuberculous meningitis in patients infected with the human immunodeficiency virus. The New England Journal of Medicine. 1992;326(10):668–672.
    1. Thwaites GE, Bang ND, Dung NH, et al. The influence of HIV infection on clinical presentation, response to treatment and outcome in adults with tuberculous meningitis. Journal of Infectious Diseases. 2005;192(12):2134–2141.
    1. Vinnard C, MacGregor RR. Tuberculous meningitis in HIV-infected individuals. Current HIV/AIDS Reports. 2009;6(3):139–145.
    1. Katrak SM, Shembalkar PK, Bijwe SR, Bhandarkar LD. The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection. Journal of the Neurological Sciences. 2000;181(1-2):118–126.
    1. Cecchini D, Ambrosioni J, Brezzo C, et al. Tuberculous meningitis in HIV-infected and non-infected patients: comparison of cerebrospinal fluid findings. International Journal of Tuberculosis and Lung Disease. 2009;13(2):269–271.
    1. Thwaites GE, Chau TTH, Stepniewska K, et al. Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. The Lancet. 2002;360(9342):1287–1292.
    1. American Thoracic Society CfDC, and infectious Diseases Society of America. Treatment of Tuberculosis. MMWR Recommendations and Reports. 2003;(RR-11) .
    1. Ormerod P, Campbell I, Novelli V, et al. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998. Thorax. 1998;53(7):536–548.
    1. Marais S, Pepper DJ, Marais BJ, Török ME. HIV-associated tuberculous meningitis: diagnostic and therapeutic challenges. Tuberculosis. 2010;90(6):367–374.
    1. Podlekareva DN, Mocroft A, Post FA, et al. Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina. Acquired Immune Deficiency Syndrome. 2009;23(18):2485–2495.
    1. Veen J, Raviglione M, Rieder HL, et al. Standardized tuberculosis treatment outcome monitoring in Europe. European Respiratory Journal. 1998;12(2):505–510.
    1. Podlekareva DN, Panteleev AM, Grint D, et al. Short and long term mortality and causes of death in HIV/TB patients in Europe. European Respiratory Journal. In press.
    1. Hakim JG, Gangaidzo IT, Heyderman RS, et al. Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients. Acquired Immune Deficiency Syndrome. 2000;14(10):1401–1407.
    1. Hamers FF, Downs AM. HIV in central and eastern Europe. The Lancet. 2003;361(9362):1035–1044.
    1. Lawn SD, Zumla AI. Tuberculosis. The Lancet. 2011;378(9785):57–72.
    1. WHO. Global tuberculosis report. 2012, .
    1. WHO TSTS. Building on and enhancing DOTS to meet the TB-related Millenium Development Goals, 2006.
    1. TB:HIV. study as part of the EuroCoord study, 2013, .

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera