ANTIRETROVIRAL THERAPY FOR THE TREATMENT OF TUBERCULOUS MENINGOENCEPHALITIS IN HIV-POSITIVE PATIENTS

Abstract

Goal of research : to assess the effect of ART on the efficacy of treatment for tuberculous meningoencephalitis in HIV-positive patients. Material and methods. We examined 70 HIV-positive patients with tuberculous meningoencefalitis, of them 16 developed tuberculosis, including meningoencephalitis, within the first three months of ART (tuberculous-associated IRIS) and 28 patients were diagnosed with TM before ART. Antiviral treatment was prescribed after taking antituberculosis drugs (main group) and 26 patients took antituberculous medications only (comparison group). Results. The characteristic features of IRIS-associated TM forms were acute onset and high incidence of generalized tuberculosis. The patients of this group observed high indices of death rate - 81,3 %, 282,6 cases/100 patient-years, which could be affected by neither antituberculosis therapy nor ART. ART included into specific chemotherapy led to decreased in-patient death rate (17,9 %, 30,1/100 patient-years) in the main group. At the same time, the development of tuberculosis-associated IRIS in the form of worsened TM course, increased intoxication, development of new pulmonary or extrapulmonary tuberculosis were detected in 14 cases (50,0 ± 9,4 %). However, only in 2 (14,3 ± 9,4 %) cases they led to death. In the comparison group, 61,5 % patients died of TM, the death rate made up 192,8/100 patients-years. The differences of the death rates between the main group and the group of comparison had statistical significance with a high level of reliability, p < 0,001. Conclusion . The inclusion of ART into the antimicobacterial therapy of non-IRIS-associated TM was accompanied by decreased indices of the in-patient death rate (43,6 % and 6,4 times decrease/100 patients-years). 50,0 ± 9,4 patients revealed symptoms of tuberculosis-associated IRIS, but only (14,3 ± 9,4 %) cases resulted in death.