The Influence of HIV Infection on Clinical Presentation, Response to Treatment, and Outcome in Adults with Tuberculous Meningitis

Abstract

HIV infection does not alter the neurological features of tuberculous meningitis but significantly reduces the survival rate.

Adenosine Deaminase (ADA) in Tuberculous Meningitis

“…One series of non-HIV-infected adult cases of CNS tuberculosis in Turkey found CSF lymphocyte predominance in 85%, neutrophil predominance in 15%, high protein levels in 77%, hypoglycorrachia in 67.2%, and elevated opening pressure in 54% of patients (Sutlas et al 2003). Similar results among a series of pediatric cases were also noted (Yaramis et al 1998), and coinfection with HIV does not appear to alter the CSF proûle (Thwaites et al 2005). Although hypoglycorrachia is common in both bacterial meningitis and TBM, its presence may provide a convenient discriminating feature that distinguishes these etiologies from most other causes of meningoencephalitis, especially when considering the initiation of empirical antibiotics.…”

Causes of Death in HIV-infected Persons Who Have Tuberculosis, Thailand

“…Among patients who died of TB, delayed TB diagnosis may be partially responsible.. Of the 38 patients who died of TB, 30 had disseminated TB, MDR-TB, or complicated extrapulmonary TB, conditions that are diffi cult to diagnose, occur frequently in HIV-infected persons, and have high death rates (13,33,34). Hospitalization at enrollment was strongly associated with increased risk for death caused by TB but not death due to other causes, which further suggests that delay in TB diagnosis may be partially responsible.…”

Suboptimal Exposure to Anti‐TB Drugs in a TBM/HIV+ Population Is Not Related to Antiretroviral Therapy

“…A strong association between HIV and TB has been shown globally where it is estimated that 25% of TB deaths could be related to HIV 4 and the viral infection has been shown to increase the risk of developing TBM (10% of HIV -ve patients with latent TB are expected to develop TBM in their life time, but if the patient is HIV+ve they would have a 10% chance to develop TBM every year 5 ) . HIV coinfection with TBM is also associated with higher mortality 6 . The treatment of HIV infection requires long-term antiretroviral therapy (ART), which may result in drug-drug interactions with many other drug classes, including antituberculosis (anti-TB) agents.…”