Thursday, June 11, 2009
Bacterial Meningitis in HIV-1-Infected Patients in the Era of Highly Active Antiretroviral Therapy.
J Acquir Immune Defic Syndr. 2009 Jun
Domingo P, Suarez-Lozano I, Torres F, Pomar V, Ribera E, Galindo MJ, Cosin J, Garcia-Alcalde ML, Vidal F, Lopez-Aldeguer J, Roca B, Gonzalez J, Lozano F, Garrido M; on behalf of the VACH Cohort Study Group.
From the *Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; daggerHospital Infanta Elena, Huelva, Spain; double daggerLaboratori de Bioestadística i Epidemiologia (Universitat Autònoma de Barcelona), IDIBAPS (Hospital Clínic), Barcelona, Spain; section signHospital Vall d'Hebrón, Barcelona, Spain; parallelHospital Clinico, Valencia, Spain; paragraph signHospital Gregorio Marañón, Madrid, Spain; #Hospital de Cabueñes, Gijón, Spain; **Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona; daggerdaggerHospital La Fe, Valencia, Spain; double daggerdouble daggerHospital General, Castellón, Spain; section sign section signHospital La Paz, Madrid, Spain; parallel parallelHospital de Valme, Sevilla, Spain; and paragraph sign paragraph signVACH Data Management Group, Huelva, Spain.
The burden that spontaneous bacterial meningitis (SBM) currently represents among HIV-1-infected patients is poorly known.
We prospectively evaluated 32 episodes of SBM in HIV-1-infected patients from the VACH (VIH-Aplicación de Control Hospitalario) Cohort and compared findings with those of 267 episodes in uninfected persons, matched by age and year of infection. A group of 13,187 HIV-1-infected patients from the VACH Cohort were used to identify predictors for acquiring SBM.
Between 1997 and 2006, we found 32 episodes of SBM among HIV-1-infected patients for an annual incidence rate of 62.0 cases per 100,000 population compared with 3.2 (3.0 to 3.4) per 100,000 population for uninfected patients (P <>/=200/mm count was the only predictor for developing SBM. Compared with uninfected, HIV-1-infected patients with SBM had a greater prevalence of primary extrameningeal infection, especially pneumonia (P = 0.02), bacteremia (P = 0.02), focal neurologic signs (P = 0.005), seizures (P = 0.06), a lower cerebrospinal fluid to blood glucose ratio (P = 0.02), and a lower prevalence of nuchal rigidity (P = 0.005). Streptococcus pneumoniae was the most frequent etiologic agent among HIV-1-infected patients. HIV-1-infected patients had neurologic complications more frequently (P = 0.02), a higher overall case fatality rate (P = 0.004), and greater incidence of neurologic sequelae (P = 0.001). '
Even in the highly active antiretroviral therapy era, the risk of developing SBM is 19 times higher among HIV-1-infected patients than among uninfected ones. It tends to present in severely immunosuppressed patients not previously vaccinated and off antiretroviral therapy, with a concomitant extrameningeal infection, bacteremia, and focal neurologic signs, and is caused by S. pneumoniae. SBM in HIV-1-infected patients carries a worse prognosis than in uninfected ones both in terms of lethality and sequelae.
PMID: 19512939 [PubMed - as supplied by publisher]