Clinical and Laboratory Characteristics and Mortality Factors in HIV- Infected Patients with Tuberculosis Meningitis at a Tertiary Care Hospital in Karachi

Abstract

Objective: To assess the clinical features, laboratory and cerebrospinal fluid (CSF) characteristics, and to determine the factors associated with mortality among HIV-infected patients diagnosed with tuberculosis meningitis (TBM).

Methodology: A retrospective observational study was conducted at the Indus Hospital, Karachi, including all HIV-positive adult patients (aged 14–75 years) diagnosed with TBM on clinical, radiological, or microbiological grounds between January 2008 and December 2024. Demographic, clinical, laboratory, and treatment related data were retrieved from hospital records, and patients were followed for in-hospital outcomes. The associations between clinical/laboratory variables and mortality were analyzed using chi-square exact tests, with p < 0.05 taken as statistically significant.

Results: The majority of males around 70%, with an overall median age of 32 years, mostly presented with headache (85%), fever (80%), altered consciousness (65%), and neck stiffness (60%), with seizures reported in around 25% of patients. Most of the cases (75%) were with advanced HIV disease. GeneXpert positivity was in 10.4% and AFB culture positivity in 12.5% of patients. Concurrent pulmonary TB was identified in 45% and extra-pulmonary TB in around 20% of cases. Around 40% of patients had BMRC Grade III and the overall mortality rate was 30%. Overall mortality was significantly higher in patients with a CD4 count below 100 cells/μL, BMRC grade III, delayed ATT initiation beyond 2 weeks, lack of corticosteroid uses  and concurrent pulmonary or extra-pulmonary TB (p>0.05), along with TBM plus extra-pulmonary TB, as key predictors of poor outcomes.

Conclusion: HIV-infected TBM patients typically presented as young males with advanced immunosuppression, headache, fever, and altered consciousness, with low CD4 count, high BMRC grade, delayed treatment, opportunistic infection and concurrent TB emerging as the principal mortality predictors and corticosteroid use associated with better outcomes, collectively highlighting the need for early diagnosis and strengthened TB-HIV collaborative care.