Characteristics of tuberculous meningitis in HIV-infected patients

Background: Tuberculous 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. Methods: We 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). Results: We 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. Conclusions: HIV 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.