Adding Streptomycin to an Intensified Regimen for Tuberculous Meningitis Improves Survival in HIV-Infected Patients

Abstract EN

In low- and middle-income countries, the mortality of HIV-associated tuberculous meningitis (TM) continues to be unacceptably high.

In this observational study of 228 HIV-infected patients with TM, we compared the mortality during the first nine months of patients treated with standard antituberculosis therapy (sATT), intensified ATT (iATT), and iATT with streptomycin (iATT + STM).

The iATT included levofloxacin, ethionamide, pyrazinamide, and double dosing of rifampicin and isoniazid and was given only during the hospital admission (median 7 days, interquartile range 6–9).

No mortality differences were seen in patients receiving the sATT and the iATT.

However, patients receiving the iATT + STM had significant lower mortality than those in the sATT group (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.24 to 0.93).

After adjusting for other covariates, the mortality hazard of the iATT + STM versus the sATT remained statistically significant (adjusted HR 0.2, 95% CI 0.09 to 0.46).

Other factors associated with mortality were previous ATT and low albumin concentrations.

The mortality risk increased exponentially only with CD4+ lymphocyte concentrations below 100 cells/μL.

In conclusion, the use of iATT resulted in a clinically important reduction in mortality compared with the standard of care only if associated with STM.

The results of this study deserve further research.