Clinical Profile and Treatment Response in Tuberculous Meningitis- A Comparison between HIV Positive and HIV Negative Patients

Abstract

Introduction: Tuberculous Meningitis (TBM) is a common infection in patients with Human Immunodeficiency Virus (HIV) and it shows significant differences in clinical profile, treatment response, and outcome compared to patients without HIV infection. Aim: To describe the clinical presentation, laboratory parameters, and radiological findings of TBM patients with and without HIV co-infection and to observe differences between them in treatment response, complications, and mortality. Materials and Methods: This was a prospective observational study, conducted on 80 TBM patients with (n=40) and without (n=40) HIV co-infection at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India, from from March 2016 to August 2017. Demographic, clinical, laboratory data, and various imaging findings were noted at the start of the study and at three and six months follow-up, for any changes from baseline to know the treatment response. Appropriate statistical tests were applied, and p-value less than 0.05 were considered statistically significant. Results: Mean age of HIV patients was 36.75 years and that of the non HIV patients was 29.35 years. Altered sensorium (90% in HIV and 72.5% in non HIV), seizures (50% in HIV and 20% in non HIV) were common in HIV patients, and weight loss (95% in non HIV and 87.5% in HIV) was common in non HIV patients. Common signs noted were nuchal rigidity (90% in HIV and 87.5% in the non HIV group), focal neurological deficit (50% in HIV and 22.5% in non HIV), and cranial nerve palsy (37.5% in HIV and 12.5% in non HIV). Anaemia was seen in 56.3% (87.5% in HIV and 25% in non HIV) and raised Erythrocyte Sedimentation Rate (ESR) was seen in 56.3% (25% in HIV and 87.5% in non HIV) patients. Tuberculoma was the most common (32.5%) Magnetic Resonance Imaging (MRI) brain finding. Adverse drugs reactions due to Antitubercular Treatment (ATT) (other causes ruled out) were seen in 22.5% of HIV patients (none in non HIV), and Antiretroviral Therapy (ART)-induced Adverse Drugs Effects (ADE) was noted in 10% of patients. Patient survival was better among non HIV (65%) compared to HIV (55%) patients. Multidrug-resistant Tuberculosis (MDR-TB) was more prevalent in HIV (7.5%) than non HIV (2.5%) cases. Conclusion: TBM involves a younger population, has a worse prognosis in HIV co-infection patients with more adverse reactions to treatment.

Keywords

• antiretroviral therapy
• antituberculous therapy
• human immunodeficiency virus
• tuberculosis