Characteristics of tuberculous meningitis in HIV‐infected patients

Abstract

BackgroundTuberculous meningitis (TBM) has a substantial mortality even with anti‐tuberculous treatment, in HIV‐non‐infected patients. Purpose of the study. The objectives were to describe clinical and laboratory differences of TBM in HIV‐infected versus HIV non‐infected patients and to assess risk factors of death in HIV‐infected patients.MethodsWe retrospectively analyzed patients admitted to four infectious diseases hospitals in Romania, between 2001 and 2011, with TBM. Patients were defined as having TBM according to a consensus definition published by Marais et al. [1] and further divided into three categories of TBM (definite, probable and possible).ResultsWe identified 162 patients with TBM of which 47 (29%) tested positive for HIV infection. Sixty‐six patients had definite, 53 probable and 43 possible TBM. Out of the 47 HIV‐infected patients 25 had definite, 17 probable and 5 possible TBM. TBM in HIV‐infected patients vs. HIV non‐infected patients was significantly associated in multivariable analysis with younger age (p=0.01), in‐hospital mortality (p<0.001), absence of meningean syndrome (p=0.021), and absence of cranial nerve palsy (p=0.036). HIV‐infected patients who died had a median CD4 count of 61 cells/mm3 (IQR 21‐132) vs. 135 cells/mm3 (IQR 61–255) in patients who survived (p=0.014). HIV infection was diagnosed before TBM episode in 35 (75%) patients. Twenty‐four (51%) HIV‐infected patients had concomitant extra‐central nervous system tuberculosis.ConclusionsHIV infection is associated with increased mortality in patients with TBM. Most of our patients with TBM were late presenters. Death in HIV infected patients was associated with a lower median CD4 count. HIV‐infected HIV‐non‐infected p‐value Male N (%) 32 (68) 68 (59) 0.287 Age (years) (median, IQR) 22 (18–34) 34 (20–51) 0.005 Duration of symptoms before admission (days) (median, IQR) 10 (7–14) 10 (7–14) 0.878 Cranial nerve palsy N (%) 6 (13) 31 (27) 0.051 Meningean syndrome N (%) 34 (72) 102 (89) 0.010 Glasgow Coma Scale<7 N (%) 11 (23) 18 (16) 0.243 Cell number in CSF (cells/mm3) (median, IQR) 180 (91–457) 200 (86–400) 0.799 Protein CSF level (mg/dl) (median, IQR) 175 (120–542) 198 (129–279) 0.701 CSF/serum glucose<0.5 N (%) 32 (71) 96 (84) 0.079 In‐hospital mortality N (%) 18 (38) 13 (11) <0.001