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- Title
TB Meningitis in HIV-Positive Patients in Europe and Argentina: Clinical Outcome and Factors Associated with Mortality.
- Authors
Efsen, Anne Marie W; Panteleev, Alexander M; Grint, Daniel; Podlekareva, Daria N; Vassilenko, Anna; Rakhmanova, Aza; Zeltina, Indra; Losso, Marcelo H; Miller, Robert F; Girardi, Enrico; Caylá, Joan; Post, Frank A; Miro, Jose M; Bruyand, Mathias; Furrer, Hansjakob; Obel, Niels; Lundgren, Jens D; Mocroft, Amanda; Kirk, Ole; 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 = 53.41 (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.
- Publication
BioMed Research International, 2013, Vol 2013, p373601
- ISSN
2314-6133
- Publication type
Journal Article
- DOI
2013/373601