TB meningitis in HIV-positive patients in Europe and Argentina: Clinical dutcome and factors associated with mortality

Anne Marie W Efsen, Alexander M. Panteleev, Daniel Grint, Daria N. Podlekareva, Anna Vassilenko, Aza Rakhmanova, Indra Zeltina, Marcelo H. Losso, Robert F. Miller, Enrico Girardi, Joan Caylá, Frank A. Post, Jose M. Miro, Mathias Bruyand, Hansjakob Furrer, Niels Obel, Jens D. Lundgren, Amanda Mocroft, Ole Kirk

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Abstract

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.

Original languageEnglish
Article number373601
JournalBioMed Research International
Volume2013
DOIs
Publication statusPublished - 2013

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Meningeal Tuberculosis
Argentina
HIV
Mortality
Public health
Eastern Europe
Lung
Incidence
CD4 Lymphocyte Count
HIV Infections
Acquired Immunodeficiency Syndrome
Public Health
Therapeutics

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)

Cite this

Efsen, A. M. W., Panteleev, A. M., Grint, D., Podlekareva, D. N., Vassilenko, A., Rakhmanova, A., ... Kirk, O. (2013). TB meningitis in HIV-positive patients in Europe and Argentina: Clinical dutcome and factors associated with mortality. BioMed Research International, 2013, [373601]. https://doi.org/10.1155/2013/373601

TB meningitis in HIV-positive patients in Europe and Argentina : Clinical dutcome and factors associated with mortality. / 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.

In: BioMed Research International, Vol. 2013, 373601, 2013.

Research output: Contribution to journalArticle

Efsen, AMW, Panteleev, AM, Grint, D, Podlekareva, DN, Vassilenko, A, Rakhmanova, A, Zeltina, I, Losso, MH, Miller, RF, Girardi, E, Caylá, J, Post, FA, Miro, JM, Bruyand, M, Furrer, H, Obel, N, Lundgren, JD, Mocroft, A & Kirk, O 2013, 'TB meningitis in HIV-positive patients in Europe and Argentina: Clinical dutcome and factors associated with mortality', BioMed Research International, vol. 2013, 373601. https://doi.org/10.1155/2013/373601
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. / TB meningitis in HIV-positive patients in Europe and Argentina : Clinical dutcome and factors associated with mortality. In: BioMed Research International. 2013 ; Vol. 2013.
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abstract = "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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T1 - TB meningitis in HIV-positive patients in Europe and Argentina

T2 - Clinical dutcome and factors associated with mortality

AU - Efsen, Anne Marie W

AU - Panteleev, Alexander M.

AU - Grint, Daniel

AU - Podlekareva, Daria N.

AU - Vassilenko, Anna

AU - Rakhmanova, Aza

AU - Zeltina, Indra

AU - Losso, Marcelo H.

AU - Miller, Robert F.

AU - Girardi, Enrico

AU - Caylá, Joan

AU - Post, Frank A.

AU - Miro, Jose M.

AU - Bruyand, Mathias

AU - Furrer, Hansjakob

AU - Obel, Niels

AU - Lundgren, Jens D.

AU - Mocroft, Amanda

AU - Kirk, Ole

PY - 2013

Y1 - 2013

N2 - 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.

AB - 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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