Clinical characteristics and prognosis of human immunodeficiency virus infected patients with tuberculous meningitis / 中华传染病杂志

ABSTRACT

Objective To investigate the impact of human immunodeficiency virus(HIV) infection on clinical characteristics and short term outcome of tuberculous meningitis (TBM).Methods One hundred and fifty-one cases of TBM patients were retrospectively collected from Chongqing Public Health Medical Center between January 2015 and December 2015.Among them,61 were infected with HIV (HIV/TBM group) and 90 were without HIV infection (TBM group).Clinical manifestations,whether complicated by pulmonary tuberculosis,cerebrospinal fluid parameters and CD4+ T lymphocyte counts and their clinical outcomes were compared.Chi square test,t test and non-parameter test were used.Results The incidences of fever,headache,vomiting and meningeal irritation sign in HIV/TBM group were 80.3％ (49),90.2％ (55),47.5％ (29) and 8.2％ (5),respectively,and those in TBM group were 88.9％ (80),88.9％ (80),47.8％ (43) and 17.8％ (16),all of which showed no significant differences (x2=2.141,0.062,0.001 and 2.787,respectively,all P＞0.05).HIV-infected patients had higher percentage of altered consciousness (34.4 ％ vs 16.7 ％,x2 =6.316,P＜0.05),whereas patients without HIV infection had higher percentages of night sweating and pulmonary tuberculosis than those with HIV infection (60.0％ vs31.1％,x2=12.120;97.8％ vs73.8％,x2=19.958,both P＜0.05).The mean value of cerebrospinal pressures in patients with HIV infection was 218.4 mmH2O (1 mmH2O =0.009 8 kPa),which was significantly lower than that of patients without HIV infection (263.6 mmH2O)(t=-2.240,P＜0.05).The median CD4+ T cell counts in HIV/TBM group was 62 (1-540) cells/μL,while that in TBM group was 291 (16 1 689) cells/μL,with significant difference (Z=-7.994,P＜0.01).There was no statistical difference in CSF parameters,imaging findings and in-hospital mortality between two groups (all P＞0.05).Conclusions HIV infected TBM patients are more likely to have altered consciousness,and less likely to have high CSF pressure and pulmonary tuberculosis.Patients with HIV/TBM eoinfection have comparable CSF parameters,head imaging findings and short-term outcomes compared with TBM patients without HIV infection.