TY - JOUR
T1 - Bacterial meningitis in HIV-1-infected patients in the era of highly active antiretroviral therapy
AU - Domingo, Pere
AU - Suarez-Lozano, Ignacio
AU - Torres, Ferran
AU - Pomar, Virginia
AU - Ribera, Esteban
AU - Galindo, Ma Jose
AU - Cosin, Jaime
AU - Garcia-Alcalde, Ma Luisa
AU - Vidal, Francesc
AU - Lopez-Aldeguer, Jose
AU - Roca, Bernardino
AU - Gonzalez, Juan
AU - Lozano, Fernando
AU - Garrido, Myriam
PY - 2009/8/1
Y1 - 2009/8/1
N2 - BACKGROUND:: The burden that spontaneous bacterial meningitis (SBM) currently represents among HIV-1-infected patients is poorly known. METHODS:: 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. RESULTS:: 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 < 0.001). The last CD4 ≤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). CONCLUSIONS:: 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. Copyright © 2009 by Lippincott Williams & Wilkins.
AB - BACKGROUND:: The burden that spontaneous bacterial meningitis (SBM) currently represents among HIV-1-infected patients is poorly known. METHODS:: 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. RESULTS:: 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 < 0.001). The last CD4 ≤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). CONCLUSIONS:: 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. Copyright © 2009 by Lippincott Williams & Wilkins.
KW - Bacterial meningitis
KW - HIV-1 infection
KW - Pneumococcal disease
KW - Pneumococcal vaccine
KW - Prognosis
KW - Streptococcus pneumoniae
U2 - 10.1097/QAI.0b013e3181adcb01
DO - 10.1097/QAI.0b013e3181adcb01
M3 - Article
VL - 51
SP - 582
EP - 587
IS - 5
ER -
