Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting

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dc.contributor.authorMarais, Suzaanen_ZA
dc.contributor.authorPepper, Dominique Jen_ZA
dc.contributor.authorSchutz, Charlotteen_ZA
dc.contributor.authorWilkinson, Robert Jen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.date.accessioned2016-01-11T06:53:33Z
dc.date.available2016-01-11T06:53:33Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: Mycobacterium tuberculosis is a common, devastating cause of meningitis in HIV-infected persons. Due to international rollout programs, access to antiretroviral therapy (ART) is increasing globally. Starting patients with HIV-associated tuberculous meningitis (TBM) on ART during tuberculosis (TB) treatment may increase survival in these patients. We undertook this study to describe causes of meningitis at a secondary-level hospital in a high HIV/TB co-infection setting and to determine predictors of mortality in patients with TBM. METHODS: A retrospective review of cerebrospinal fluid findings and clinical records over a six-month period (March 2009-August 2009). Definite, probable and possible TBM were diagnosed according to published case definitions. RESULTS: TBM was diagnosed in 120/211 patients (57%) with meningitis. In 106 HIV-infected patients with TBM, six-month all-cause mortality was lower in those who received antiretroviral therapy (ART) during TB treatment; hazard ratio = 0.30 (95% CI = 0.08-0.82). Factors associated with inpatient mortality in HIV-infected patients were 1) low CD4 + count at presentation; adjusted odds ratio (AOR) = 1.4 (95% confidence interval [CI] = 1.03-1.96) per 50 cells/µL drop in CD4 + count and, 2) higher British Medical Research Council TBM disease grade (2 or 3 versus 1); AOR = 4.8 (95% CI = 1.45-15.87). Interpretation Starting ART prior to or during TB treatment may be associated with lower mortality in patients with HIV-associated TBM. Advanced HIV and worse stage of TBM disease predict in-hospital mortality in patients presenting with TBM.en_ZA
dc.identifier.apacitationMarais, S., Pepper, D. J., Schutz, C., Wilkinson, R. J., & Meintjes, G. (2011). Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting. <i>PLoS One</i>, http://hdl.handle.net/11427/16284en_ZA
dc.identifier.chicagocitationMarais, Suzaan, Dominique J Pepper, Charlotte Schutz, Robert J Wilkinson, and Graeme Meintjes "Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/16284en_ZA
dc.identifier.citationMarais, S., Pepper, D. J., Schutz, C., Wilkinson, R. J., & Meintjes, G. (2011). Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting. PloS one, 6(5), e20077. doi:10.1371/journal.pone.0020077en_ZA
dc.identifier.ris TY - Journal Article AU - Marais, Suzaan AU - Pepper, Dominique J AU - Schutz, Charlotte AU - Wilkinson, Robert J AU - Meintjes, Graeme AB - BACKGROUND: Mycobacterium tuberculosis is a common, devastating cause of meningitis in HIV-infected persons. Due to international rollout programs, access to antiretroviral therapy (ART) is increasing globally. Starting patients with HIV-associated tuberculous meningitis (TBM) on ART during tuberculosis (TB) treatment may increase survival in these patients. We undertook this study to describe causes of meningitis at a secondary-level hospital in a high HIV/TB co-infection setting and to determine predictors of mortality in patients with TBM. METHODS: A retrospective review of cerebrospinal fluid findings and clinical records over a six-month period (March 2009-August 2009). Definite, probable and possible TBM were diagnosed according to published case definitions. RESULTS: TBM was diagnosed in 120/211 patients (57%) with meningitis. In 106 HIV-infected patients with TBM, six-month all-cause mortality was lower in those who received antiretroviral therapy (ART) during TB treatment; hazard ratio = 0.30 (95% CI = 0.08-0.82). Factors associated with inpatient mortality in HIV-infected patients were 1) low CD4 + count at presentation; adjusted odds ratio (AOR) = 1.4 (95% confidence interval [CI] = 1.03-1.96) per 50 cells/µL drop in CD4 + count and, 2) higher British Medical Research Council TBM disease grade (2 or 3 versus 1); AOR = 4.8 (95% CI = 1.45-15.87). Interpretation Starting ART prior to or during TB treatment may be associated with lower mortality in patients with HIV-associated TBM. Advanced HIV and worse stage of TBM disease predict in-hospital mortality in patients presenting with TBM. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0020077 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting TI - Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting UR - http://hdl.handle.net/11427/16284 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16284
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0020077
dc.identifier.vancouvercitationMarais S, Pepper DJ, Schutz C, Wilkinson RJ, Meintjes G. Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting. PLoS One. 2011; http://hdl.handle.net/11427/16284.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightscredited.en_ZA
dc.rights.holder© 2011 Marais et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherCerebrospinal fluiden_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherMeningitisen_ZA
dc.subject.otherHistory of tuberculosisen_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherInpatientsen_ZA
dc.titlePresentation and outcome of tuberculous meningitis in a high HIV prevalence settingen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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