Mortality Associated with Tuberculosis Meningitis in HIV Infected Patients and Non-HIV Infected Patients: Tuberculosis Meningitis in Infected and Non-HIV Infected Patients

Salma Haji; Munir Afzal; Waseem Akram; Atif Ahmed; Beenish Memon; Monika Kumari

doi:10.54393/pjhs.v6i1.2694

Authors

Salma Haji Department of Neurology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
Munir Afzal Department of Neurology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
Waseem Akram Department of Pathology, People’s University of Medical and Health Science for Women, Nawabshah, Pakistan
Atif Ahmed Department of Medicine, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Beenish Memon Department of Medicine, Liaquat University Hospital, Hyderabad, Pakistan
Monika Kumari Department of Neurology, Jinnah Medical and Dental College, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i1.2694

Keywords:

Tuberculosis Meningitis, Human Immunodeficiency Virus, Mortality, Infarction

Abstract

Human Immunodeficiency Virus (HIV) infection significantly worsens Tuberculosis meningitis (TBM) outcomes, leading higher mortality rate in HIV-positive patients compared to HIV-negative individuals. Objectives: To find out the frequency of HIV Infected Patients with TBM and their outcome as mortality and to compare their mortality of TBM without HIV infection. Methods: This cross-sectional-observational study was conducted at Jinnah Postgraduate Medical Center Karachi, from September 2020 to October 2024. All patients diagnosed with TBM on clinical findings and Cerebrospinal Fluid analysis as TBM were admitted an HIV test was carried out and a CD4 cell count was done in HIV-positive patients. Treatment with Anti-Tuberculosis Therapy and Antiretroviral Therapy was done, the outcome as mortality was recorded up to 1 year and results were analyzed by SPSS version 26.0. Results: A total of 260 patients were enrolled who presented with TBM. The mean age was 39 ± 12.7 years. 20/260 (7.69%) were HIV positive and 240/260 (92.3%) were HIV negative TBM patients. 130/240 (54.16%) were male and 110/240 (45.93%) were female in HIV-negative and HIV-positive TBM 12/20 (60%) were male and 8/20 (40%) patients were female. age in HIV-positive patients was 32.5 ± 5.5 and 38.5 ± 6 in HIV-negative patients. 13/20 (65%) HIV-positive patients expired and 55/240 (22.9%) of HIV-negative patients expired. Conclusions: It was concluded that HIV Infected patients in our setup were increasing and had a high mortality rate as compared to HIV-negative patients of TBM and TBM patients presented in stage 3 had high mortality in both HIV-positive and HIV-negative patients.

References

Haji S. Outcome of Tuberculous Meningitis in Adults. Journal of Liaquat University of Medical and Health Sciences. 2019 Apr; 18(01): 28-33. doi: 10.22442/jlumhs.191810597.

Luo M, Wang W, Zeng Q, Luo Y, Yang H, Yang X. Tuberculous Meningitis Diagnosis and Treatment in Adults: A Series of 189 Suspected Cases. Experimental and Therapeutic Medicine. 2018 Sep; 16(3): 2770-6. doi: 10.3892/etm.2018.6496.

Haji S. Presentation of Tuberculous Meningitis. Journal of Liaquat University of Medical & Health Sciences. 2020 Oct; 19(03): 167-70.

Pandey NG, Yadav DS, Chavan SA, Padhiyar RN, KarniK ND. Clinical Profile and Treatment Response in Tuberculous Meningitis-A Comparison between HIV Positive and HIV Negative Patients. Journal of Clinical and Diagnostic Research. 2022 May; 16(5). doi: 10.7860/JCDR/2022/51702.16336.

Soria J, Metcalf T, Mori N, Newby RE, Montano SM, Huaroto L et al. Mortality in Hospitalized Patients with Tuberculous Meningitis. BioMed Central Infectious Diseases. 2019 Dec; 19: 1-7. doi: 10.1186/s12879-018-3633-4.

Ramos AP and Burneo JG. Seizures and Epilepsy Associated with Central Nervous System Tuberculosis. Seizure: European Journal of Epilepsy. 2023 Apr; 107: 60-6. doi: 10.1016/j.seizure.2023.03.006.

Robert M, Mageau A, Gaudemer A, Thy M, Peiffer Smadja N, de Lastours V et al. Incidence, Risk Factors and Treatment of Central Nervous System Immune Reconstitution Inflammatory Syndrome in Non‐HIV Patients with Tuberculous Meningitis: A Multi-Centre Observational Study. Internal Medicine Journal. 2024 May; 54(5): 802-8. doi: 10.1111/imj.16295.

Naidoo K, Rampersad S, Karim SA. Improving Survival with Tuberculosis and HIV Treatment Integration: A Mini-Review. Indian Journal of Medical Research. 2019 Aug; 150(2): 131-8. doi: 10.4103/ijmr.IJMR_660_19.

Raza HA, Raja MH, Khakwani MM, Jamil B. Pakistan's HIV High-Risk Populations: Critical Appraisal of Failure to Curtail Spread Beyond Key Populations. International Journal of Infectious Diseases Regions. 2024 Apr: 100364. doi: 10.1016/j.ijregi.2024.100364.

PASS N. Power Analysis and Sample Size Software. NCSS LLC: Kaysville, UT, USA. 2021.

Maitre T, Bonnet M, Calmy A, Raberahona M, Rakotoarivelo RA, Rakotosamimanana N et al. Intensified Tuberculosis Treatment to Reduce the Mortality of HIV-Infected and Uninfected Patients with Tuberculosis Meningitis (INTENSE-TBM): Study Protocol for A Phase III Randomized Controlled Trial. Trials. 2022 Nov; 23(1): 928. doi: 10.1186/s13063-022-06772-1.

Seyoum E, Demissie M, Worku A, Mulu A, Berhane Y, Abdissa A. Increased Mortality in HIV Infected Individuals with Tuberculosis: A Retrospective Cohort Study, Addis Ababa, Ethiopia. HIV/AIDS-Research and Palliative Care. 2022 Mar: 143-54. doi: 10.2147/HIV.S354436.

Mahashabde ML, Bhimani YR, Bhavsar HM, Sriram J. A Rare Modality of Concurrent Cryptococcal and Tubercular Meningitis in a Patient Living with HIV. Cureus. 2024 Aug; 16(8): e66032. doi: 10.7759/cureus.66032.

World Health Organization. Global Tuberculosis Report 2024. World Health Organization. 2024 Oct.

Annex W. Global Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections. 2021.

Taylor MM, Wi T, Gerbase A, Thwin SS, Gottlieb S, Babovic MT et al. Assessment of Country Implementation of the WHO Global Health Sector Strategy On Sexually Transmitted Infections (2016-2021). PLoS One. 2022 May; 17(5): e0263550. doi: 10.1371/journal.pone.0263550.

Misra UK and Kalita J, Tuberculous Meningitis International Research Consortium. Mechanism, Spectrum, Consequences and Management of Hyponatremia in Tuberculous Meningitis. Welcome Open Research. 2021 Mar; 4: 189. doi: 10.12688/wellcomeopenres.15502.2.

Derseh NM, Agimas MC, Aragaw FM, Birhan TY, Nigatu SG, Alemayehu MA et al. Incidence Rate of Mortality and Its Predictors Among Tuberculosis and Human Immunodeficiency Virus Coinfected Patients On Antiretroviral Therapy in Ethiopia: Systematic Review and Meta-Analysis. Frontiers in Medicine. 2024 Apr; 11: 1333525. doi: 10.3389/fmed.2024.1333525.

Seid G, Alemu A, Dagne B, Gamtesa DF. Microbiological Diagnosis and Mortality of Tuberculosis Meningitis: Systematic Review and Meta-Analysis. PLoS One. 2023 Feb; 18(2): e0279203. doi: 10.1371/journal.pone.0279203.

Navasardyan I, Abdou A, Kades S, Misakyan Y, Ochsner J, Subbian S et al. Tuberculosis Meningitis Coexisting with HIV Infection: A Comprehensive Review. Frontiers in Tuberculosis. 2023 Oct; 1: 1242869. doi: 10.3389/ftubr.2023.1242869.