Abstract
Objective: We intend to investigate the relapse of HIV-associated cryptococcal meningitis (CM), assess potential predictors and conduct survival analysis, with a view to establishing a valid reference for the management of the relapse of CM.Method: This is a retrospective study in Chinese patients with HIV-associated CM and those who experience relapse of CM. Baseline demographic, laboratory and clinical characteristics of patients with HIV-associated CM were collected. Predictors for relapse of HIV-associated CM were analyzed using univariate and multivariate logistic regression. Survival probability in relapse cases was determined by Kaplan-Meier survival curves.Results: During the study period, 87 of 348 (25.0%) HIV patients experienced the relapse of CM. CD4+ T-cell counts, antiretroviral therapy (ART) status and the time from symptom onset to presentation were all statistically associated with the relapse of CM (p = 0.013, 0.018 and 0.042, respectively). The overall survival among 46 HIV CM relapse patients whose survival information were obtained, was 78.3%. The proportion of patients who died after antifungal treatment for CM was greater in those whose interval from symptom onset to presentation ≥4 weeks, compared with those <4 weeks (p = 0.0331).Conclusions: In order to reduce the relapse of CM and increase the survival possibility of these patients, we can promote the importance of ART before CM occurs, emphasize timely consultation when any CM-associated clinical symptoms occurs, and individualized the timing of ART initiation according to indicators which can reflect the severity of CM.
Highlights
Cryptococcal meningitis (CM) remains a major cause of mortality related to human immunodeficiency virus (HIV) infection [1], and the CM-associated mortality is as high as 15% globally in HIV-infected populations [2]
The median baseline HIV RNA viral load was 75,550 copies/mL (IQRs, 0– 352,250) in all patients with HIV-associated CM, and 156,500 copies/mL (IQRs, 5,167–377,169) in those who experienced a relapse of CM
The median cerebrospinal fluid (CSF) white-cell count in patients with HIV-associated CM was 20 cells/mm3 (IQRs, 0.3–93), and that in those who experienced a relapse of CM was 0.05 cells/mm3 (IQRs, 0.3–93)
Summary
Cryptococcal meningitis (CM) remains a major cause of mortality related to human immunodeficiency virus (HIV) infection [1], and the CM-associated mortality is as high as 15% globally in HIV-infected populations [2]. Even after appropriate antifungal treatment for CM, HIV-associated CM has a high relapse rate. The relapse rate for HIV-associated CM has not been systematically reported in China, and this is especially significant because the currently recommended induction treatment regimen in China [4] is not consistent with that recommended by WHO [5]. Previous studies conducted before 2005 have reported that several risk factors are associated with the relapse of CM among HIV-infected patients. Not receiving flucytosine during the initial 2 weeks of primary treatment for cryptococcal disease is reported to be a factor associated with relapse of culture positive CM [7]. The preceding studies analyzed risk factors for the relapse of HIV-associated CM from the perspective of induction and maintenance treatment. The mortality rate among relapse cases of CM, and the potential factors influencing survival in these patients have not been investigated previously
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