CLINICAL CORRELATES OF SECONDARY MENINGITIS IN HIV-INFECTED ADULTS

Background: Neurologic complaints are common in adults infected with t he human immunodeficiency virus, but little is known about which clini cal features are associated with secondary causes of meningitis. Metho ds: A retrospective cross-sectional study of adults infected with the human immunodeficiency virus who received a diagnostic lumbar puncture (LP) in the infectious disease clinic, emergency department, and inpa tient wards of the Deaconess Hospital, Boston, Mass, from 1989 through 1992 to determine which clinical features available at the time of LP are correlated with definite or probable secondary meningitis. Result s: Of the 491 LPs, 90% were performed in whites, 93% in men, and 11% i n injection drug users. Cerebrospinal fluid test results revealed seco ndary meningitis in 39 (7.9%) of 491 LPs performed on 322 individuals. Cryptococcal meningitis was the predominant type (27 cases); no bacte rial or tuberculous meningitis was found. In multivariate analyses, a history of non-Hodgkin's lymphoma (adjusted odds ratio [OR], 4.3; 95% confidence interval [CI], 1.5 to 12.5), a history of herpes simplex vi rus infection (OR, 2:5; 95% CI, 1.2 to 5.0), nausea and/or vomiting (O R, 2.0; 95% CI, 1.03 to 4.0), headache in a person with the acquired i mmunodeficiency syndrome (OR, 2.1; 95% CI, 1.03 to 4.4), and cranial n erve abnormalities (OR, 5.1; 95% CI, 1.8 to 14.1) were positive correl ates of opportunistic meningitis; current fluconazole use (OR, 0.3; 95 % CI, 0.1 to 0.8) conferred a lower risk. Conclusion: In similar clini cal settings, physicians and their human immunodeficiency virus-infect ed patients should consider these features when assessing the risk of secondary meningitis and the necessity for immediate LP.