Outcome of Ventriculoperitoneal Shunt Surgery in Human Immunodeficiency Virus-Positive Patients on Combination Antiretroviral Therapy with Tuberculosis Meningitis and Hydrocephalus.

Autor: Harrichandparsad R; Department of Neurosurgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. Electronic address: Harrichandparsad@ukzn.ac.za., Nadvi SS; Department of Neurosurgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa., Suleman Moosa MY; Department of Infectious Diseases, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa., Rikus van Dellen J; Bupa Cromwell Hospital, West London, London, United Kingdom.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2019 Mar; Vol. 123, pp. e574-e580. Date of Electronic Publication: 2018 Dec 07.
DOI: 10.1016/j.wneu.2018.11.221
Abstrakt: Background: In 2000, we advised against insertion of a ventriculoperitoneal shunt (VPS) in human immunodeficiency virus (HIV)-positive patients with tuberculous meningitis (TBM) complicated by hydrocephalus. However, this was in the era when combination antiretroviral therapy (ART) was not freely available in South Africa. In this subsequent preliminary report, we describe the outcome of ventriculoperitoneal shunting in patients with TBM and hydrocephalus who are HIV positive and receiving ART.
Methods: We compared a group of 15 HIV-positive patients with TBM and hydrocephalus on ART with a retrospective control group of 15 patients (demographically and clinically matched) but not on ART. All patients were otherwise managed similarly and evaluated at 1 month after VPS insertion.
Results: In historical controls, 10 patients died (66.7%) and no patient showed any improvement 1 month after shunting. In contrast, in the current group on ART, 4 patients died (26.7%), with 11 patients (73.3%) having a good outcome. Eight of 12 patients with grade 3 TBM had a good outcome, whereas all 3 with grade 1 TBM made a good recovery.
Conclusions: The outcome of VP shunting in HIV-positive patients with TBM and hydrocephalus is markedly improved in patients on ART. Based on limited data from this study, we recommend that better grades of TBM (1 and 2) undergo immediate VPS surgery. Patients with grade 4 TBM should undergo a trial of external ventricular drainage and those who improve should undergo a definitive procedure. Further research is required for patients with grade 3 TBM to identify characteristics associated with better outcomes to allow for effective use of limited resources.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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