{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:48:29Z","timestamp":1791557309543,"version":"4.3.4"},"reference-count":148,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,1,19]],"date-time":"2020-01-19T00:00:00Z","timestamp":1579392000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["RP\u20102017\u201008\u2010ST2\u2010012"],"award-info":[{"award-number":["RP\u20102017\u201008\u2010ST2\u2010012"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["F32AI140511"],"award-info":[{"award-number":["F32AI140511"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>HIV\u2010associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub\u2010Saharan Africa (SSA). We performed a systematic review and meta\u2010analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized\u2010controlled trials (RCTs) or investigator\u2010managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short\u2010term (in\u2010hospital or two weeks), medium\u2010term (up to 10 weeks) and long\u2010term (up to six months).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results and discussion<\/jats:title>\n                    <jats:p>Seventy\u2010nine studies met inclusion criteria. In routine care settings, pooled short\u2010term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole\u2010based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short\u2010term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short\u2010term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized\u2010controlled trials. Few studies evaluated long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mortality rates from HIV\u2010associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV\u2010associated meningitis in the region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25416","type":"journal-article","created":{"date-parts":[[2020,1,19]],"date-time":"2020-01-19T22:58:32Z","timestamp":1579474712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Mortality from HIV\u2010associated meningitis in sub\u2010Saharan Africa: a systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8702-8393","authenticated-orcid":false,"given":"Mark W","family":"Tenforde","sequence":"first","affiliation":[{"name":"Division of Allergy and Infectious Diseases University of Washington School of Medicine Seattle WA USA"},{"name":"Department of Epidemiology University of Washington School of Public Health Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-3793","authenticated-orcid":false,"given":"Alida M","family":"Gertz","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5439-4039","authenticated-orcid":false,"given":"David S","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership Gaborone Botswana"},{"name":"Department of Clinical Research Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9471-5397","authenticated-orcid":false,"given":"Nicola K","family":"Wills","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine London United Kingdom"},{"name":"Welcome Centre for Infectious Diseases Research in Africa Infectious Disease and Molecular Medicine Unit University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2059-3291","authenticated-orcid":false,"given":"Brandon L","family":"Guthrie","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington School of Public Health Seattle WA USA"},{"name":"Department of Global Health University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carey","family":"Farquhar","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases University of Washington School of Medicine Seattle WA USA"},{"name":"Department of Epidemiology University of Washington School of Public Health Seattle WA USA"},{"name":"Department of Global Health University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1459-5554","authenticated-orcid":false,"given":"Joseph N","family":"Jarvis","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership Gaborone Botswana"},{"name":"Department of Clinical Research Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,19]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNAIDS.Fact sheet \u2010 latest statistics on the status of the AIDS epidemic. 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