Tuberculosis in HIV-associated cryptococcal meningitis is associated with an increased risk of death

Morris K. Rutakingirwa, Fiona V. Cresswell, Richard Kwizera, Kenneth Ssebambulidde, Enock Kagimu, Edwin Nuwagira, Lillian Tugume, Edward Mpoza, Joanna Dobbin, Darlisha A. Williams, Conrad Muzoora, David B. Meya, David R. Boulware, Kathy H. Hullsiek, Joshua Rhein

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. Data are limited on TB co-infection among individuals with cryptococcal meningitis. We performed a retrospective analysis of HIV-infected participants with cryptococcal meningitis from 2010–2017. Baseline demographics were compared between three groups: ‘prevalent TB’ if TB treated >14 days prior to cryptococcal meningitis diagnosis, ‘concurrent TB’ if TB treated ± 14 days from diagnosis, or ‘No TB at baseline’. We used time-updated proportional-hazards regression models to assess TB diagnosis as a risk for death. Of 870 participants with cryptococcal meningitis, 50 (6%) had prevalent TB, 67 (8%) had concurrent TB, and 753 (86%) had no baseline TB. Among participants without baseline TB, 67 (9%) were diagnosed with incident TB (after >14 days), with a median time to TB incidence of 41 days (IQR, 22–69). The 18-week mortality was 50% (25/50) in prevalent TB, 46% (31/67) in concurrent TB, and 45% (341/753) in the no TB group (p = 0.81). However, TB co-infection was associated with an increased hazard of death (HR = 1.75; 95% CI, 1.33–2.32; p < 0.001) in a time-updated model. TB is commonly diagnosed in cryptococcal meningitis, and the increased mortality associated with co-infection is a public health concern.

Original languageEnglish (US)
Article number781
JournalJournal of Clinical Medicine
Volume9
Issue number3
DOIs
StatePublished - Mar 2020

Bibliographical note

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • AIDS-related opportunistic infections
  • Co-infection
  • Cryptococcal meningitis
  • Cryptococcus
  • HIV
  • Tuberculosis

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