Tuberculous meningoencephalitis in the Brazilian pediatric population: the impact of HIV on clinical outcomes from 2015 to 2024

Abstract

Background: Tuberculous meningoencephalitis is the most severe form of tuberculosis, with high morbidity and mortality, and coinfection with HIV can worsen the condition. Objective: To analyze the impact of HIV on the clinical outcome of pediatric tuberculous meningoencephalitis in Brazil from 2015 to 2024. Methods: Cross-sectional descriptive study with data from SINAN/DATASUS. Confirmed cases of tuberculous meningoencephalitis in patients aged 0 to 19 years from 2015 to 2024 were analyzed. The analyzed variables included HIV status, use of antiretroviral therapy, clinical outcomes (cure and deaths), and the conduct of rapid molecular tests, stratified by sex and age group (under 1 year, 1-4, 5-9, 10-14, and 15-19 years old). The incidence was calculated per 100,000 inhabitants using IBGE population estimates. The time-trend analysis used Spearman correlation, and comparisons between groups were performed using the chi-squared test, with p<0.05 considered statistically significant. The database did not contain information regarding BCG vaccination or neurological sequelae. Results: 985 cases of pediatric tuberculous meningoencephalitis were registered from 2015 to 2024, with an incidence of 0.16/100,000 inhabitants and temporal stability (p=0.455). The incidence varied significantly within the age groups (p=0.0001), with the highest incidence being in infants under 1 year of age (0.64/100,000), followed by 1-4 years old (0.23), 15-19 years old (0.16), 10-14 years old (0.11), and 5-9 years old (0.09). Babies under 1 year old presented a risk four times greater than adolescents. Regarding HIV, 7.3% were positive, 66.5% were negative, 23.9% were not tested, and 2.2% were ongoing/ignored, resulting in a prevalence of 9.9% within the tested patients. 54.2% of HIV-positive cases reported the use of antiretroviral drugs, without reference to the drug chosen, while 23.6% had missing data. There was no difference between sexes (p=0.966). The lethality in HIV-positive individuals was 34.7%, while in HIV-negative individuals it was 21.8%, indicating a higher risk of death in coinfection (OR=1.91; 95% CI 1.14-3.21; p=0.013). The cure rate reached 31.9% in HIV-positive individuals and 46.6% in HIV-negative individuals. The rapid molecular test was performed in 37.7% of cases, detecting rifampicin sensitivity in 56.1% and resistance in 2.2%. Conclusion: Pediatric tuberculous meningoencephalitis presents a high lethality rate, with a higher risk of death in coinfection with HIV, although cure rates remain unsatisfactory in both groups. The lack of data on neurological outcomes and BCG vaccination, along with the high proportion of missing or blank information, limits understanding of the disease's functional impact and jeopardizes a more comprehensive analysis. The concentration of cases in infants under 1 year of age highlights the vulnerability of this age group and reinforces the need for targeted strategies for early diagnosis, contact tracing, and chemoprophylaxis.