To describe the epidemiology, clinical manifestations, cerebrospinal fluid (CSF) characteristics, and outcomes of community-acquired meningitis (CAM) in HIV-infected patients.
Retrospective study of adults admitted with CAM to several hospitals in New Orleans, LA and Houston, TX between 1998 and 2010. Only patients that underwent HIV testing were eligible for the study. An adverse clinical outcome was defined as a Glasgow outcome score of 1-4.
A total of 549 adults with CAM were identified; 417 (76%) without HIV infection, and 132 (24%) with HIV infection. HIV infected patients were younger, had higher rates of comorbidities, and history of injection drug use (P<0.05). HIV infected adults had higher rates of elevated CSF protein, hypoglycorrachia, abnormal cranial imaging, syphilis, and cryptococcal meningitis (P<0.05). In contrast, HIV uninfected adults were more likely to have higher serum white cell counts and to have enterovirus (P<0.05). There were no differences in the clinical presentations between the two groups or rates of adverse clinical outcomes. Logistic regression identified hypoglycorrachia and an abnormal neurologic exam as independent predictor factors of worse outcome in all patients with meningitis.
HIV infected patients with meningitis have more severe CSF findings on presentation and different etiology. However, clinical outcomes are similar than in non HIV infected patients.
K. J. Vigil,
R. Hasbun, None