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. © 2013 Anne Marie W. Efsen et al.
TB meningitis in HIV-positive patients in Europe and Argentina: Clinical dutcome and factors associated with mortality / Efsen, A. M. W.; Panteleev, A. M.; Grint, D.; Podlekareva, D. N.; Vassilenko, A.; Rakhmanova, A.; Zeltina, I.; Losso, M. H.; Miller, R. F.; Girardi, E.; Cayla, J.; Post, F. A.; Miro, J. M.; Bruyand, M.; Furrer, H.; Obel, N.; Lundgren, J. D.; Mocroft, A.; Kirk, O.; Toibaro, J. J.; Warley, E.; Tamayo, N.; Cristina Ortiz, M.; Scapelatto, P.; Bottaro, E.; Murano, F.; Miachans, M.; Contarelli, J.; Massera, L.; Corral, J.; Hualde, M.; Miglioranza, C.; Corti, M.; Metta, H.; Casiro, A.; Cuini, R.; Laplume, H.; David, D.; Marson, C.; Lupo, S.; Trape, L.; Garcia Messina, O.; Gear, O.; Bruguera, J. M.; Karpov, I.; Skrahina, E.; Skrahin, A.; Zhavoronok, S.; Mitsura, V.; Ruzanov, D.; Bondarenko, V.; Suetnov, O.; Paduto, D.; Gerstoft, J.; Kronborg, G.; Pedersen, C.; Larsen, C. S.; Pedersen, G.; Laursen, A. L.; Nielsen, L.; Jensen, J.; Dabis, F.; Chene, G.; Lawson-Ayayi, S.; Thiebaut, R.; Wittkop, L.; Morlat, P.; Bonnet, F.; Bernard, N.; Hessamfar, M.; Lacoste, D.; Vandenhende, M. A.; Dupon, M.; Dauchy, F. A.; Dutronc, H.; Longy-Boursier, M.; Mercie, P.; Duffau, P.; Roger Schmeltz, J.; Malvy, D.; Pistone, T.; Receveur, M. C.; Neau, D.; Cazanave, C.; Ochoa, A.; Vareil, M. O.; Pellegrin, J. L.; Viallard, J. F.; Greib, C.; Lazaro, E.; Fleury, H.; Lafon, M. E.; Reigadas, S.; Trimoulet, P.; Breilh, D.; Molimard, M.; Bouchet, S.; Titier, K.; Moreau, J. F.; Pellegrin, I.; Haramburu, F.; Arcachon, G.; Dupont, A.; Gerard, Y.; Caunegre, L.; Andre, K.; Bonnal, F.; Farbos, S.; Gemain, M. C.; Ceccaldi, J.; Tchamgoue, S.; De Witte, S.; Courtault, K.; Monlun, E.; Gaborieau, V.; Lataste, P.; Meraud, J. P.; Chossat, I.; Carvalho, A. C.; Basche, R.; Hamad, I. E.; Ricci, B. A.; Maggiolo, F.; Ravasio, V.; Mussini, C.; Prati, F.; Castelletti, S.; Ammassari, A.; Antinori, A.; Bellagamba, R.; Busi Rizzi, E.; Cicalini, S.; Corpolongo, A.; Capaldo, A.; Di Caro, A.; Goletti, D.; Grisetti, S.; Gualano, G.; Lauria, F. N.; Parracino, L.; Palmieri, F.; Petrosillo, N.; Pinetti, C.; Sampaolesi, A.; Moroni, M.; Angarano, G.; Armignacco, O.; d'Arminio Monforte, A.; Castelli, F.; Cauda, R.; Di Perri, G.; Galli, M.; Iardino, R.; Ippolito, G.; Lazzarin, A.; Perno, C. F.; von Schloesser, F.; Viale, P.; Castagna, A.; Ceccherini-Silberstein, F.; Cozzi-Lepri, A.; Lo Caputo, S.; Puoti, M.; Andreoni, M.; Balotta, C.; Bonfanti, P.; Bonora, S.; Borderi, M.; Capobianchi, M. R.; Cingolani, A.; Cinque, P.; De Luca, A.; Di Biagio, A.; Gianotti, N.; Gori, A.; Guaraldi, G.; Lapadula, G.; Lichtner, M.; Madeddu, G.; Marchetti, G.; Marcotullio, S.; Monno, L.; Quiros Roldan, E.; Rusconi, S.; Cicconi, P.; Fanti, I.; Formenti, T.; Galli, L.; Lorenzini, P.; Giacometti, A.; Costantini, A.; Carrisa, C.; Suardi, C.; Vanino, E.; Verucchi, G.; Minardi, C.; Quirino, T.; Abeli, C.; Manconi, P. E.; Piano, P.; Vecchiet, J.; Falasca, K.; Sighinolfi, L.; Segala, D.; Mazzotta, F.; Cassola, G.; Viscoli, G.; Alessandrini, A.; Piscopo, R.; Mazzarello, G.; Mastroianni, C.; Belvisi, V.; Caramma, I.; Castelli, A. P.; Rizzardini, G.; Ridolfo, A. L.; Piolini, R.; Salpietro, S.; Carenzi, L.; Moioli, M. C.; Puzzolante, C.; Abrescia, N.; Chirianni, A.; Guida, M. G.; Gargiulo, M.; Baldelli, F.; Francisci, D.; Parruti, G.; Ursini, T.; Magnani, G.; Ursitti, M. A.; Vullo, V.; D'Avino, A.; Gallo, L.; Nicastri, E.; Acinapura, R.; Capozzi, M.; Libertone, R.; Tebano, G.; Cattelan, A.; Mura, M. S.; Caramello, P.; Orofino, G. C.; Sciandra, M.; Pellizzer, G.; Manfrin, V.; Riekstina, V.; Aldins, P.; Duiculescu, D.; Malashenkov, E.; Kozlov, A.; Buzunova, S.; Garcia-Goez, J. F.; Moreno Camacho, A.; Martinez, J. A.; Gonzalez, J.; Garcia-Alcaide, F.; de Lazzari, E.; Gatell, J. M.; Sanchez, P.; Lopezcolomes, J. L.; Martinez-Lacasa, X.; Falco, V.; Imaz, A.; Ocana, I.; Vidal, R.; Sambeat, M. A.; Moreno-Martinez, A.; Orcau, A.; Weber, R.; Battegay, M.; Hirschel, B.; Cavassini, M.; Bernasconi, E.; Schmid, P.; Rickenbach, M.; Campbell, L.; Arenas-Pinto, A.; Chentsova, N.; Kjaer, J.. - In: BIOMED RESEARCH INTERNATIONAL. - ISSN 2314-6133. - 2013:(2013), pp. 1-9. [10.1155/2013/373601]
TB meningitis in HIV-positive patients in Europe and Argentina: Clinical dutcome and factors associated with mortality
Corti M.;David D.;Nielsen L.;Mussini C.;Palmieri F.;Bonfanti P.;Bonora S.;Guaraldi G.;Marchetti G.;Costantini A.;Sighinolfi L.;Piscopo R.;Puzzolante C.;Gallo L.;Kozlov A.;Bernasconi E.;
2013
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. © 2013 Anne Marie W. Efsen et al.File | Dimensione | Formato | |
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