Author(s): Butler EK, Boulware DR, Bohjanen PR, Meya DB, Butler EK, Boulware DR, Bohjanen PR, Meya DB
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Abstract Data presented previously as an abstract at the 2011 CUGH Global Health Conference in Montreal, Canada on 15 Nov 2011. The long-term survival of HIV-infected persons with symptomatic cryptococcal meningitis and asymptomatic, subclinical cryptococcal antigenemia (CRAG+) is unknown. We prospectively enrolled 25 asymptomatic, antiretroviral therapy (ART)-naïve CRAG+ Ugandans with CD4<100 cells/mcL who received pre-emptive fluconazole treatment (CRAG+ cohort) and 189 ART-naïve Ugandans with symptomatic cryptococcal meningitis treated with amphotericin (CM cohort). The 10-week survival was 84\% (95\%CI: 70-98\%) in the CRAG+ cohort and 57\% (95\%CI: 50\%-64\%) in the CM cohort. The CRAG+ cohort had improved five-year survival of 76\% (95\%CI: 59\%-93\%) compared to 42\% (95\%CI: 35\%-50\%) in the CM cohort (P = 0.001). The two cohorts had similar immunosuppression pre-ART with median CD4 counts of 15 vs. 21 CD4/mcL in the CRAG+ and CM cohorts, respectively (P = 0.45). Despite substantial early mortality, subsequent 5-year survival of persons surviving 6-months was excellent (>88\%), demonstrating that long term survival is possible in resource-limited settings. Pre-ART CRAG screening with preemptive fluconazole treatment and improved CM treatment(s) are needed to reduce AIDS-attributable mortality due to cryptococcosis which remains 20-25\% in sub-Saharan Africa.
This article was published in PLoS One
and referenced in Journal of AIDS & Clinical Research