The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection

Background: As human immunodeficiency virus (HIV) infection primarily impai rs cellular immunity, the immune responses of HIV-infected individuals to t uberculous bacilli may be inadequate. The features of pulmonary and abdomin al tuberculosis evident in HIV-positive (HIV-P) patients with severe immuno suppression are markedly different from those seen in HIV-negative (HIV-N) patients. However, such differences have not been reported in tuberculous m eningitis (TBM). Here, we therefore compared the clinical, radiological and pathological features of TBM in patients with and without HIV infection. M ethods and results: Twenty-two HIV-P patients with TBM, seen over 5 years, were studied and compared with 31 HIV-N patients with TBM. Although clinica l features were similar, cognitive dysfunction was more common amongst the HIV-P group. Pathological features were markedly different in the HIV-P gro up reflecting severely reduced and atypical inflammatory response, and exte nsive vasculopathy. This manifested as absence or minimal meningeal enhance ment and absence of communicating hydrocephalus on CT scan in HIV-P patient s. Mortality was higher within the HIV-P group and depressed levels of cons ciousness and hemiplegia were associated with poor prognosis. Conclusion: T he clinical, radiological and pathological features of TBM in HIV-P patient s are distinctly different from those without HIV infection; a finding prev iously unreported. (C) 2000 Elsevier Science B.V. All rights reserved.