Tuberculous meningitis in patients with concurrent tuberculosis and HIV infection who have started antiretroviral therapy: the specific course and prognosis

The objective: to study the course of tuberculous meningitis (TM) in patients with HIV infection after the initiation of antiretroviral therapy (ART) and evaluate their effect on the outcome prognosis.Subjects and methods. 58 patients with concurrent tuberculosis and HIV infection were examined, in whom, after initiation of ART, TM exacerbated or developed. The mean age made 36.0 ± 1.4 years; there were 45 men (77.6%). The following groups were identified: 25 patients who were admitted with diagnosis of TM and started treatment; and after ART initiation, they experienced a worsening of meningitis course of (Group I); 17 patients who received anti-tuberculosis drugs for tuberculosis in other sites and in whom, after ART initiation, the course of tuberculosis worsened and TM developed (Group II); 16 patients who started ART at the pre-hospital stage without a previously diagnosed tuberculosis, in whom TM was one of the first manifestations of active tuberculosis (Group III).Results. Exacerbation of previously treated TM occurred in the period from 3 to 62 days (median 13.0), which was considered as a manifestation of the immune system restoration syndrome. In 20 (80.0%) patients, stabilization was achieved in the period from 30 to 278 days (median 120.0), 4 (16.0%) people died due to progression of meningitis. TM, which began for the first time after ART in patients who had taken 12 to 150 (median 40.5) doses of anti-TB drugs, developed within 5 to 90 days (median 24) and was associated with high mortality (76.5%), which could be due to drug resistance. Of the 16 patients in whom TM developed after the start of ART on an outpatient basis, active tuberculosis could not be excluded in 12 (75.0%) of them before starting treatment. Symptoms of meningitis appeared in 4-63 days (median 28.5), mortality reached 87.5%, one of the reasons could be drug resistance