CLINICAL OUTCOMES OF CRYPTOCOCCAL MENINGITIS AMONG HIV-INFECTED PATIENTS IN THE ERA OF ANTIRETROVIRAL THERAPY.
Taiichiro KobayashiPunnee PitisuttithumJaranit KaewkingwalAngsana PhuphuakratSomnuek SungkanuparphPublished in: The Southeast Asian journal of tropical medicine and public health (2018)
Cryptococcal meningitis (CM) is a common opportunistic infection in
HIV-infected patients and the clinical outcome can be severe. This study aimed to
determine the survival rate and prognostic factors among HIV-infected patients
with CM in the era of antiretroviral therapy (ART). Understanding of these facts
may help clinicians to manage CM patients efficiently and patients with poor
prognostic factors could be closely monitored. We conducted a retrospective cohort
study among new cases of HIV-associated CM who were treated at Ramathibodi
Hospital, Mahidol University, Thailand, during 2002-2013. Of 195 patients, 119
(61%) were male; the median (interquartile range, IQR) age was 33 (29-39) years.
The median (IQR) CD4 cell count was 20 (9-44) cells/mm3. The median survival
time was >12 years and the 75% survival time was 5 years. Using the Cox proportional
hazard model, the factors associated with mortality were impaired consciousness
[hazard ratio (HR)=2.38; 95% confidence interval (CI): 1.03-5.50], low
initial cerebrospinal fluid (CSF) protein (≤60 mg/dl) (HR=2.88; 95%CI: 1.13-7.35),
low initial CSF glucose (≤30 mg/dl) (HR=2.36; 95%CI: 1.01-5.51), high opening
pressure during induction therapy (>25 cmH2O) (HR=2.90, 95%CI: 1.21-6.94), no
ART (HR=14.8; 95%CI: 5.39-40.7) and relapse of CM (HR=4.31; 95%CI: 1.42-13.1).
The HIV-associated CM survival rate in the ART era is higher than it was during
the pre-ART era.
Keyphrases
- antiretroviral therapy
- hiv infected
- hiv infected patients
- prognostic factors
- human immunodeficiency virus
- hiv positive
- hiv aids
- cerebrospinal fluid
- end stage renal disease
- newly diagnosed
- ejection fraction
- free survival
- chronic kidney disease
- induced apoptosis
- cardiovascular disease
- blood pressure
- stem cells
- oxidative stress
- mesenchymal stem cells
- emergency department
- coronary artery disease
- metabolic syndrome
- bone marrow
- patient reported outcomes
- insulin resistance
- skeletal muscle
- peripheral blood
- palliative care
- acute care
- cell cycle arrest