Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis. Tenforde, M. W., Gertz, A. M., Lawrence, D. S., Wills, N. K., Guthrie, B. L., Farquhar, C., & Jarvis, J. N. Journal of the International AIDS Society, 23(1):e25416, NLM (Medline), jan, 2020.
Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis [link]Paper  doi  abstract   bibtex   
INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region.
@article{Tenforde2020,
abstract = {INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44{\%} (95{\%} confidence interval (95{\%} CI):39{\%} to 49{\%}, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21{\%} (95{\%} CI:17{\%} to 25{\%}), 17 studies). Pooled short-term mortality of TB meningitis was 46{\%} (95{\%} CI: 33{\%} to 59{\%}, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54{\%} in routine care settings (95{\%} CI:44{\%} to 64{\%}, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region.},
author = {Tenforde, Mark W. and Gertz, Alida M. and Lawrence, David S. and Wills, Nicola K. and Guthrie, Brandon L. and Farquhar, Carey and Jarvis, Joseph N.},
doi = {10.1002/jia2.25416},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tenforde et al. - 2020 - Mortality from HIV-associated meningitis in sub-Saharan Africa a systematic review and meta-analysis.pdf:pdf},
issn = {17582652},
journal = {Journal of the International AIDS Society},
keywords = {OA,TB meningitis,cryptococcal meningitis,fund{\_}not{\_}ack,pneumococcal meningitis,review,sub-Saharan Africa,systematic review},
mendeley-tags = {OA,fund{\_}not{\_}ack,review},
month = {jan},
number = {1},
pages = {e25416},
pmid = {31957332},
publisher = {NLM (Medline)},
title = {{Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis}},
url = {https://onlinelibrary.wiley.com/doi/abs/10.1002/jia2.25416},
volume = {23},
year = {2020}
}
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