Neurological TB in HIV

Abstract

Central nervous system (CNS) tuberculosis (TB) is the worst form of TB and may present as (1) intracranial pathology, including tuberculous meningitis (TBM), tuberculoma/abscess, and rarely cerebritis or encephalopathy (described in children) and, (2) intraspinal disease. HIV co-infection increases the risk of developing CNS TB substantially, especially in patients with severe immunosuppression (CD4 count <100 cells/μL). In this chapter, we discuss the pathogenesis, clinical and imaging findings, management and outcomes of the most frequent forms of CNS TB in HIV co-infected patients. We further review the features and management of a frequently fatal complication related to starting antiretroviral therapy (ART), namely neurological TB immune reconstitution inflammatory syndrome (IRIS).