PURPOSE: Cryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines and determined predictors of survival. DESIGN: A computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005-2009. Medical records were reviewed. Kaplan-Meier survival curves were generated. Bivariate and multivariate Cox proportional hazards models were used to determine associations between key clinical characteristics and survival. RESULTS: Medical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR: 10-705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4 cell count, receipt of highly active anti-retroviral therapy, and treatment with any anti-fungal therapy. CONCLUSIONS: Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.
PURPOSE:Cryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines and determined predictors of survival. DESIGN: A computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005-2009. Medical records were reviewed. Kaplan-Meier survival curves were generated. Bivariate and multivariate Cox proportional hazards models were used to determine associations between key clinical characteristics and survival. RESULTS: Medical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR: 10-705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4 cell count, receipt of highly active anti-retroviral therapy, and treatment with any anti-fungal therapy. CONCLUSIONS:Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.
Authors: Sara A Mirza; Maureen Phelan; David Rimland; Edward Graviss; Richard Hamill; Mary E Brandt; Tracie Gardner; Matthew Sattah; Gabriel Ponce de Leon; Wendy Baughman; Rana A Hajjeh Journal: Clin Infect Dis Date: 2003-02-27 Impact factor: 9.079
Authors: C M van der Horst; M S Saag; G A Cloud; R J Hamill; J R Graybill; J D Sobel; P C Johnson; C U Tuazon; T Kerkering; B L Moskovitz; W G Powderly; W E Dismukes Journal: N Engl J Med Date: 1997-07-03 Impact factor: 91.245
Authors: M S Saag; W G Powderly; G A Cloud; P Robinson; M H Grieco; P K Sharkey; S E Thompson; A M Sugar; C U Tuazon; J F Fisher Journal: N Engl J Med Date: 1992-01-09 Impact factor: 91.245
Authors: Neil French; Katherine Gray; Christine Watera; Jessica Nakiyingi; Eric Lugada; Michael Moore; David Lalloo; James A G Whitworth; Charles F Gilks Journal: AIDS Date: 2002-05-03 Impact factor: 4.177
Authors: H Mayanja-Kizza; K Oishi; S Mitarai; H Yamashita; K Nalongo; K Watanabe; T Izumi; K Augustine; R Mugerwa; T Nagatake; K Matsumoto Journal: Clin Infect Dis Date: 1998-06 Impact factor: 9.079
Authors: L de Vedia; A Arechavala; M I Calderón; E Maiolo; A Rodríguez; N Lista; E Di Virgilio; J C Cisneros; R Prieto Journal: Infection Date: 2013-12 Impact factor: 3.553
Authors: Radha Rajasingham; Rachel M Smith; Benjamin J Park; Joseph N Jarvis; Nelesh P Govender; Tom M Chiller; David W Denning; Angela Loyse; David R Boulware Journal: Lancet Infect Dis Date: 2017-05-05 Impact factor: 25.071
Authors: A-C L Meyer; C K Kendi; J A Penner; N Odhiambo; B Otieno; E Omondi; E Opiyo; E A Bukusi; C R Cohen Journal: Trop Med Int Health Date: 2013-02-01 Impact factor: 2.622
Authors: Katelyn A Pastick; Ananta S Bangdiwala; Mahsa Abassi; Andrew G Flynn; Bozena M Morawski; Abdu K Musubire; Prosperity C Eneh; Charlotte Schutz; Kabanda Taseera; Joshua Rhein; Kathy Huppler Hullsiek; Melanie R Nicol; Jose E Vidal; Noeline Nakasujja; Graeme Meintjes; Conrad Muzoora; David B Meya; David R Boulware Journal: Open Forum Infect Dis Date: 2019-11-05 Impact factor: 3.835