<![CDATA[Tuberculous meningitis (TBM) is a form of extrapulmonary tuberculosis characterized by neurological complications and high mortality. HIV co-infection further elevates this risk. Clinical presentations and outcomes vary significantly between HIV-positive and HIV-negative patients, yet data from Indonesia remain limited. This study aimed to compare the clinical characteristics, presenting symptoms, and outcomes of HIV-positive and HIV-negative TBM patients at Dr. Saiful Anwar General Hospital, Malang, Indonesia. This retrospective study used electronic medical records of TBM patients treated from June to December 2023, including demographics, clinical symptoms, and outcomes. Inclusion criteria required age >18 years, a probable or confirmed TBM diagnosis by the Marais Score, and documented HIV status; exclusion criteria included incomplete records and other CNS infections. Statistical analysis included frequency distribution, Fisher's exact test, odds ratio, and multivariable logistic regression. Among 36 patients, the majority were male (72.2%) and aged 15–30 years (33%). Common symptoms included fever, seizures, decreased consciousness, headache, meningeal signs, and pulmonary tuberculosis. Overall mortality was 47.2%, with higher crude mortality in HIV-positive than HIV-negative patients (80% vs. 42%; OR 5.54, p=0.12). After adjustment, BMRC disease severity emerged as the strongest independent predictor of mortality (p=0.004), while HIV status was no longer significant. These findings suggest that disease severity at presentation, rather than HIV status itself, largely explains the excess mortality, though HIV-positive patients still appeared to have worse clinical outcomes overall. Early diagnosis and severity-based triage remain important regardless of HIV status, and larger studies are needed to confirm these findings.]]>
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