ORIGINAL RESEARCH article

Front. Public Health

Sec. Infectious Diseases: Epidemiology and Prevention

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1600104

Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study

Provisionally accepted
  • 1Salvador University, Salvador, Bahia, Brazil
  • 2Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil

The final, formatted version of the article will be published soon.

Introduction: Tuberculous meningitis (TBM) is a severe form of central nervous system infection caused by Mycobacterium tuberculosis (Mtb) that is often associated with significant morbidity and mortality, particularly in people living with HIV (PLWH). This study investigated differences in clinical and laboratory profiles of TBM cases in Brazil associated with HIV status, and identified factors associated with in-hospital mortality.We conducted a retrospective analysis of 1,819 hospitalized adult TBM patients reported in the Brazilian Notifiable Diseases Information System (SINAN) meningitis database from 2007 to 2021.Confirmed cases in hospitalized individuals aged >18 years with known HIV status were included; pregnant patients were excluded. Clinical and laboratory features were compared by HIV status and clinical outcomes.Classification and regression tree analysis was used to identify outcome-based cut-off values for selected continuous variables. Associations with in-hospital mortality were assessed using backward stepwise binomial logistic regressions.The majority (57%) of TBM cases comprised of PLWH, who exhibited lower frequencies of vomiting, nuchal rigidity, signs of meningeal inflammation, and coma, along with lower leukocyte counts in cerebrospinal fluid (CSF) compared to HIV-negative patients. PLWH also displayed lower mortality rates (17.3% vs. 23.2%, p=0.002). Features independently associated with mortality included seizures (aOR: 2.15,

Keywords: tuberculous meningitis, HIV, Clinical presentation, Risk factors, Brazil

Received: 25 Mar 2025; Accepted: 02 Jun 2025.

Copyright: © 2025 Urmenyi, Vinhaes, Villalva, Araújo-Pereira and Andrade. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Bruno B. Andrade, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil

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