Abstract
Background: South Africa has 7.06 million people who are HIV-positive, with those having a low CD4 count being susceptible to cryptococcal meningitis (CCM), which has an estimated mortality of 30–50%. This study aimed to establish the outcome of patients admitted with CCM to a regional hospital in Durban between June 2015 and May 2016, and the extent to which the National Department of Health (NDoH) protocol was adhered to in managing their condition.Method: This retrospective observational descriptive study reviewed the records of patients ≥ 12 years old admitted with CCM between June 2015 and May 2016, from which their demographic and medical data were extracted.Results: Seventy-six complete records were found of which 49 were men and 27 were women. The average CD4 count was 55.9 cells/mm3, 85.5% were treated with intravenous amphotericin B and high-dose oral fluconazole, 6.7% received only amphotericin B and 5.2% received only fluconazole. There was an in-hospital mortality of 31.6%, and the NDoH protocol was adhered to in 72.4% (55/76) of patients. There was, however, no significant difference in outcome between those who were and were not managed as per the protocol (p = 0.177).Discussion and conclusion: In-hospital mortality for CCM continues to be significant despite high rates of adherence to the NDoH protocol in the majority of patients. For this to be addressed, early diagnosis of HIV and initiation of ART to prevent the profound immunosuppression is essential.
Highlights
By the end of 2016, 36.7 million people were living with HIV/ AIDS worldwide, of whom almost 52% (19 million) resided in sub-Saharan Africa (SSA).[1,2] South Africa (SA) has the largest HIV epidemic in the world, with an estimated 7.06 million people who are HIV-positive (+ve)[3] and a national HIV prevalence rate of approximately 12.6%.3 KwaZulu-Natal province, with the country’s second highest population, is the epicentre of the South African HIV epidemic
Patients given the correct doses of amphotericin B and fluconazole, and who had monitoring bloods taken on three occasions, were assessed to have been managed according to the National Department of Health (NDoH) protocol
64 patients had their CD4 count recorded in their files and/or were traceable on the National Health Laboratory services (NHLS) lab-track, and the average CD4 count was 55.9 cells/mm3 ± 57.4 (Figure 1)
Summary
By the end of 2016, 36.7 million people were living with HIV/ AIDS worldwide, of whom almost 52% (19 million) resided in sub-Saharan Africa (SSA).[1,2] South Africa (SA) has the largest HIV epidemic in the world, with an estimated 7.06 million people who are HIV-positive (+ve)[3] and a national HIV prevalence rate of approximately 12.6%.3 KwaZulu-Natal province, with the country’s second highest population, is the epicentre of the South African HIV epidemic. A number of strategies have been introduced in SA that could have an impact on the mortality associated with CCM These include the UNAIDS 90–90–90 initiative[8] (90% of the population to know their status, 90% of those who are HIV + ve to be on treatment and 90% of those on treatment to be virally suppressed by 2020); proactively screening all patients with a CD4 count ≤ 100 cells/mm[3] for cryptococcal antigens (CrAg); carefully assessing those who are CrAg + ve for CCM; and adding high-dose fluconazole to the treatment regimen for patients admitted with CCM. Discussion and conclusion: In-hospital mortality for CCM continues to be significant despite high rates of adherence to the NDoH protocol in the majority of patients. For this to be addressed, early diagnosis of HIV and initiation of ART to prevent the profound immunosuppression is essential
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