Advancing Diagnosis and Treatment in People Living with HIV and Tuberculosis Meningitis.

IF 3.7 2区医学 Q2 INFECTIOUS DISEASES Current HIV/AIDS Reports Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI:10.1007/s11904-023-00678-6

Sarah Kimuda, Derrick Kasozi, Suzan Namombwe, Jane Gakuru, Timothy Mugabi, Enock Kagimu, Morris K Rutakingirwa, Kristoffer E Leon, Felicia Chow, Sean Wasserman, David R Boulware, Fiona V Cresswell, Nathan C Bahr

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Abstract

Purpose of review: Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Inadequate diagnostic testing and treatment regimens adapted from pulmonary tuberculosis without consideration of the unique nature of TBM are among the potential drivers. This review focuses on the progress being made in relation to both diagnosis and treatment of TBM, emphasizing promising future directions.

Recent findings: The molecular assay GeneXpert MTB/Rif Ultra has improved sensitivity but has inadequate negative predictive value to "rule-out" TBM. Evaluations of tests focused on the host response and bacterial components are ongoing. Clinical trials are in progress to explore the roles of rifampin, fluoroquinolones, linezolid, and adjunctive aspirin. Though diagnosis has improved, novel modalities are being explored to improve the rapid diagnosis of TBM. Multiple ongoing clinical trials may change current therapies for TBM in the near future.

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推进艾滋病毒和结核病患者脑膜炎的诊断和治疗。

综述目的：结核性脑膜炎（TBM）是最严重的结核病。不充分的肺结核诊断测试和治疗方案，而不考虑TBM的独特性质，是潜在的驱动因素之一。这篇综述的重点是在TBM的诊断和治疗方面取得的进展，强调了有希望的未来方向。最近的发现：分子分析GeneXpert MTB/Rif Ultra提高了灵敏度，但没有足够的阴性预测值来“排除”TBM。针对宿主反应和细菌成分的测试评估正在进行中。临床试验正在进行中，以探索利福平、氟喹诺酮类药物、利奈唑胺和辅助阿司匹林的作用。尽管诊断有所改善，但正在探索新的模式来提高TBM的快速诊断。多项正在进行的临床试验可能会在不久的将来改变目前TBM的治疗方法。

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来源期刊

Current HIV/AIDS Reports INFECTIOUS DISEASES-

CiteScore

8.10

自引率

2.20%

发文量

期刊介绍： This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of HIV/AIDS. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antiretroviral therapies, behavioral aspects of management, and metabolic complications and comorbidity. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.