CLINICAL COURSE OF TUBERCULOUS MENINGITIS IN THE CONTEXT OF HIV INFECTION

Abstract

Tuberculous meningitis is one of the most severe forms of tuberculosis and poses a significant life-threatening risk, particularly for patients living with HIV. HIV-associated immunodeficiency markedly alters the pathogenesis and clinical progression of the disease, resulting in atypical presentations, rapid progression, and a high incidence of severe neurological complications. Patients often present with prolonged fever, headache, changes in mental status, and focal neurological deficits, while classical meningeal signs may be less noticeable, leading to delays in diagnosis. Laboratory and cerebrospinal fluid findings are frequently nonspecific, and distinguishing the disease from other opportunistic central nervous system infections remains a major diagnostic challenge. Early recognition of tuberculous meningitis, timely initiation of appropriate antimicrobial therapy, and careful management of antiretroviral treatment-including prevention and control of immune reconstitution inflammatory syndrome-are critical for improving clinical outcomes in HIV-infected patients.