The effect of HIV infection on adult meningitis in Indonesia: a prospective cohort study

Abstract

Although HIV is still uncommon in the general population in Indonesia, its prevalence among adult meningitis cases already seems high. Mycobacterium tuberculosis and Cryptococcus neoformans are the main causes of meningitis in this setting, and mortality is very high, especially in HIV-infected patients. Our data suggest that adult meningitis cases in Indonesia should be screened routinely for HIV infection. Further studies are needed to address the high mortality.

Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection

“…In the present study, initial serum white count more than 11,000/mL, higher Charlson comorbidity score, and abnormal brain images were documented as independent risk factors for 90-day mortality, which indicated that underlying diseases (Charlson comorbidity score) and severe inflammatory response either systemic or in subarachnoid space 14 (abnormal brain images) were important. On the other hand, HIV infection doesnot play a role in mortality at Day 30 and Day 90 in our cases, similar to the previous study by Jean et al 28 But Ganiem et al 29 reported that 1-month mortality was higher and strongly associated with HIV infection in adult meningitis, including cryptococcal meningitis, in Indonesia. This difference in mortality could be explained by the fact that patients with HIV-positive cryptococcal meningitis admitted at NTUH routinely receive repeated lumbar puncture to relieve increased intracranial pressure (IICP), as reported by Sun et al 30 As for management of cryptococcal meningitis, the duration of induction therapy with amphotericin B in HIVinfected and noneHIV-infected individuals was different (2 weeks vs. 4e6 weeks).…”

Resistance of Asian Cryptococcus neoformans Serotype A Is Confined to Few Microsatellite Genotypes

“…Most 5FC-resistant isolates came from Indonesia and Thailand where this drug is not in use [50]–[51]. In our study, we found that approximately 35% of all MC17 isolates were resistant to 5FC.…”

Predictor of Mortality in Acquired Immunodeficiency Syndrome Patients with Central Nervous System Opportunistic Infections

“…The data support Indonesia's need for more effective prevention and detection of HIV infection as well as access to ART treatment to improve cases of AIDS related to death. 5,11 The bivariate analysis result showed altered consciousness (OR=29.944; 95% CI 6.900-129.945; p=0.0) as predictor and multivariate analysis showed ART (OR=2.968; 95% CI 1.236-7.126; p=0.015) as predictor. The multivariate analysis calculated 5 variables, to find which variable had the strongest relation to mortality cases.…”