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<jats:title>ABSTRACT</jats:title><jats:p>HIV-associated tuberculous meningitis (TBM) has high mortality. Aside from the devastating impact of multidrug resistance (MDR) on survival, little is understood about the influence of other bacterial factors on outcome. This study examined the influence of<jats:named-content xmlns:xlink="http://www.w3.org/1999/xlink" content-type="genus-species" xlink:type="simple">Mycobacterium tuberculosis</jats:named-content>drug resistance, bacterial lineage, and host vaccination status on outcome in patients with HIV-associated TBM.<jats:named-content xmlns:xlink="http://www.w3.org/1999/xlink" content-type="genus-species" xlink:type="simple">Mycobacterium tuberculosis</jats:named-content>isolates from the cerebrospinal fluid of 186 patients enrolled in two studies of HIV-associated TBM in Ho Chi Minh City, Vietnam, were tested for resistance to first-line antituberculosis drugs. Lineage genotyping was available for 122 patients. The influence of antituberculosis drug resistance and<jats:named-content xmlns:xlink="http://www.w3.org/1999/xlink" content-type="genus-species" xlink:type="simple">M. tuberculosis</jats:named-content>lineage on 9-month mortality was analyzed using Kaplan-Meier survival analysis and Cox multiple regression models. Isoniazid (INH) resistance without rifampin resistance was associated with increased mortality (adjusted hazard ratio [HR], 1.78, 95% confidence interval [CI], 1.18 to 2.66;<jats:italic>P</jats:italic>= 0.005), and multidrug resistance was uniformly fatal (<jats:italic>n</jats:italic>= 8/8; adjusted HR, 5.21, 95% CI, 2.38 to 11.42;<jats:italic>P</jats:italic>&lt; 0.0001). The hazard ratio for INH-resistant cases was greatest during the continuation phase of treatment (after 3 months; HR, 5.05 [95% CI, 2.23 to 11.44];<jats:italic>P</jats:italic>= 0.0001). Among drug-susceptible cases, patients infected with the “modern” Beijing lineage strains had lower mortality than patients infected with the “ancient” Indo-Oceanic lineage (HR, 0.29 [95% CI, 0.14 to 0.61];<jats:italic>P</jats:italic>= 0.001). Isoniazid resistance, multidrug resistance, and<jats:named-content xmlns:xlink="http://www.w3.org/1999/xlink" content-type="genus-species" xlink:type="simple">M. tuberculosis</jats:named-content>lineage are important determinants of mortality in patients with HIV-associated TBM. Interventions which target these factors may help reduce the unacceptably high mortality in patients with TBM.</jats:p>

Original publication

DOI

10.1128/aac.00319-12

Type

Journal

Antimicrobial Agents and Chemotherapy

Publisher

American Society for Microbiology

Publication Date

06/2012

Volume

56

Pages

3074 - 3079