Table of Contents Author Guidelines Submit a Manuscript
BioMed Research International
Volume 2013 (2013), Article ID 373601, 9 pages
http://dx.doi.org/10.1155/2013/373601
Research Article

TB Meningitis in HIV-Positive Patients in Europe and Argentina: Clinical Outcome and Factors Associated with Mortality

1Copenhagen HIV Programme, Rigshospitalet, Faculty of Health and Medical Sciences, Copenhagen University Hospital and University of Copenhagen, 2200 Copenhagen N, Denmark
2TB Hospital No. 2, Russian Federation, 195267 Saint Petersburg, Russia
3University College London, Royal Free Campus, London NW3 2PF, UK
4Belorusian State Medical University, Minsk 220002, Belarus
5St. Petersburg AIDS Centre, 193167 Saint Petersburg, Russia
6Infectology Centre of Latvia, 1006 Riga, Latvia
7Hospital JM Ramos Mejia, Servicio de Inmunocomprometidos, CP 1221 Buenos Aires, Argentina
8Centre for Sexual Health & HIV Research, Mortimer Market Centre, University College London, London WC1E 6JB, UK
9Istituto Nazionale Malattie Infettive L Spallanzani, 00149 Rome, Italy
10Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), 08 036 Barcelona, Spain
11King’s College London School of Medicine, London SE5 9RS, UK
12Hospital Clinic-IDIBAPS, University of Barcelona, 08 036 Barcelona, Spain
13Centre Hospitalier Universitaire (CHU) de Bordeaux, COREVIH Aquitaine, 33000 Bordeaux, France
14INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France
15Department of Infectious Diseases, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland
16Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, 2100 Copenhagen, Denmark

Received 17 May 2013; Revised 12 September 2013; Accepted 30 September 2013

Academic Editor: Antonio Pacheco

Copyright © 2013 Anne Marie W. Efsen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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) ( ; 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 ( (2.61–8.92)), and receiving care in Eastern Europe ( (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.