{
  "abstract": "Objectives For people living with HIV (PLWH) and tuberculous meningitis (TBM), current studies on risk stratification and poor prognosis lack a clear optimal threshold. To address this gap, this study aims to identify an optimal immunological threshold for risk stratification and explore predictors of poor prognosis in this population.Methods We conducted a multicentre cross-sectional study enrolling PLWH with TBM from hospitals across eight provinces of China between January 2018 and December 2020. We extracted the demographic and clinical data, discharge outcomes, Medical Research Council staging and CD4 + T-lymphocyte count on admission. CD4 thresholds were determined using restricted cubic splines with knots at quintiles. Multivariable logistic regression of risk factors derived adjusted ORs with 95% CIs.Results A total of 201 participants were included in the study. Of these, 173 (86.1%) improved with treatment. Restricted cubic spline analysis identified CD4 + T-lymphocyte count <50 cells/µL as the optimal threshold for predicting poor TBM outcomes; the median CD4+ count was significantly lower in patients who deteriorated (40 cells/µL) than in those who improved (69 cells/µL). Multivariable logistic regression confirmed CD4+ T-lymphocyte count <50 cells/µL and elevated blood urea nitrogen (BUN) as independent risk factors for adverse outcomes.Conclusions In PLWH with TBM, a CD4 + T-cell count below 50 cells/µL defines a critical stratification threshold for clinical risk classification, with elevated BUN serving as an additional prognostic marker. These findings support the prioritisation of severely immunocompromised patients for targeted management and further mechanistic studies.",
  "authors": [
    {
      "affiliations": [
        "Beijing Chest Hospital, Capital Medical University, Beijing, China",
        "Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China"
      ],
      "name": "Yuwei Li, #"
    },
    {
      "affiliations": [
        "Molecular Biology Research Centre & Centre for Medical Genetics, Central South University, Changsha, China",
        "National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China"
      ],
      "name": "Yang Zhou"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China"
      ],
      "name": "Pengfei Zhao"
    },
    {
      "affiliations": [
        "Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China"
      ],
      "name": "Yinzhong Shen"
    },
    {
      "affiliations": [
        "Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China"
      ],
      "name": "Haolan He"
    },
    {
      "affiliations": [
        "The Sixth People’s Hospital of Zhengzhou, Zhengzhou, Henan, China"
      ],
      "name": "Yan Sun"
    },
    {
      "affiliations": [
        "The Department of Infection, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China"
      ],
      "name": "Yanfen Liu"
    },
    {
      "affiliations": [
        "The Sixth People's Hospital of Zhengzhou, Zhengzhou, Henan, China"
      ],
      "name": "Qingxia Zhao"
    },
    {
      "affiliations": [
        "Mengchao Hepatobiliary Hospital, Fujian Medical University, Fuzhou, China"
      ],
      "name": "Yahong Chen"
    },
    {
      "affiliations": [
        "Xixi Hospital of Hangzhou, Hangzhou, China"
      ],
      "name": "Jianhua Yu"
    },
    {
      "affiliations": [
        "Tianjin City Second People’s Hospital, Tianjin, China"
      ],
      "name": "Ping Ma"
    },
    {
      "affiliations": [
        "Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China"
      ],
      "name": "Zhimin Chen"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China"
      ],
      "name": "Hui Wang"
    },
    {
      "affiliations": [
        "Department of Infection and Immunity, The Third People’s Hospital of Shenzhen, Shenzhen, China"
      ],
      "name": "Mingbin Zheng"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China"
      ],
      "name": "Yaokai Chen"
    },
    {
      "affiliations": [
        "Hunan University of Technology, Zhuzhou, China"
      ],
      "name": "Min Lei"
    },
    {
      "affiliations": [
        "Beijing Chest Hospital, Capital Medical University, Beijing, China",
        "Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China",
        "Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital Affiliated to Capital Medical University, Beijing, China"
      ],
      "name": "Weimin Li"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China"
      ],
      "name": "Hongzhou Lu"
    }
  ],
  "title": "Data-driven targets for predicting outcomes in patients with HIV infection and tuberculous meningitis in China",
  "uid": "40eb19a7-b104-58c6-903a-58b4ef694617"
}