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

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 ass...

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Veröffentlicht in:BioMed research international Jg. 2013; S. 1 - 9
Hauptverfasser: 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, Study Group, HIV/TB
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Hindawi Publishing Corporation 01.01.2013
John Wiley & Sons, Inc
Schlagworte:
Acquired immune deficiency syndrome
Adult
AIDS
Argentina
CD4 Lymphocyte Count
Colleges & universities
Drug therapy
Europe
Female
HIV
HIV - isolation & purification
HIV - pathogenicity
HIV Infections - complications
HIV Infections - mortality
HIV Infections - pathology
HIV Infections - therapy
HIV Infections - virology
HIV patients
Hospitals
Human immunodeficiency virus
Humans
Kaplan-Meier Estimate
Male
Medical research
Medicine, Experimental
Meningitis
Mortality
Patient outcomes
Risk Factors
Treatment Outcome
Tuberculosis
Tuberculosis, Meningeal - complications
Tuberculosis, Meningeal - mortality
Tuberculosis, Meningeal - pathology
Tuberculosis, Meningeal - therapy
Tuberculosis, Meningeal - virology
Argentina
Europe
Latvia
ISSN:2314-6133, 2314-6141, 2314-6141
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Zusammenfassung: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.
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Academic Editor: Antonio Pacheco
ISSN:2314-6133
2314-6141
2314-6141
DOI:10.1155/2013/373601