Adding Streptomycin to an Intensified Regimen for Tuberculous Meningitis Improves Survival in HIV-Infected Patients. (4th August 2015)

• Record Type: Journal Article
• Authors: Alvarez-Uria, Gerardo; Pakam, Raghavakalyan; Midde, Manoranjan; Yalla, Pradeep Sukumar; Naik, Praveen Kumar
• Other Names: Lanzafame Massimiliano Academic Editor.
• Is Part Of: Interdisciplinary perspectives on infectious diseases. Volume 2015(2015)
• Publication Date: 2015-08-04
• Subjects: Communicable diseases -- Periodicals; 571.9805
• DOI: 10.1155/2015/535134
• Languages: English
• ISSNs: 1687-708X

Abstract

Abstract : In low- and middle-income countries, the mortality of HIV-associated tuberculous meningitis (TM) continues to be unacceptably high. In this observational study of 228 HIV-infected patients with TM, we compared the mortality during the first nine months of patients treated with standard antituberculosis therapy (sATT), intensified ATT (iATT), and iATT with streptomycin (iATT + STM). The iATT included levofloxacin, ethionamide, pyrazinamide, and double dosing of rifampicin and isoniazid and was given only during the hospital admission (median 7 days, interquartile range 6–9). No mortality differences were seen in patients receiving the sATT and the iATT. However, patients receiving the iATT + STM had significant lower mortality than those in the sATT group (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.24 to 0.93). After adjusting for other covariates, the mortality hazard of the iATT + STM versus the sATT remained statistically significant (adjusted HR 0.2, 95% CI 0.09 to 0.46). Other factors associated with mortality were previous ATT and low albumin concentrations. The mortality risk increased exponentially only with CD4+ lymphocyte concentrations below 100 cells/ μ L. In conclusion, the use of iATT resulted in a clinically important reduction in mortality compared with the standard of care only if associated with STM. The results of this study deserve further research.