TY - JOUR
T1 - Short term mortality outcomes of HIV-associated Cryptococcal meningitis in antiretroviral therapy naïve and experienced patients in sub-Saharan Africa
AU - Kalata, Newton
AU - Ellis, Jayne
AU - Kanyama, Cecilia
AU - Kuoanfank, Charles
AU - Temfack, Elvis
AU - Mfinanga, Sayoki
AU - Lesikari, Sokoine
AU - Chanda, Duncan
AU - Lakhi, Shabir
AU - Nyazika, Tinashe
AU - Chan, Adrienne K.
AU - Van Oosterhout, Joep J.
AU - Chen, Tao
AU - Hosseinipour, Mina C.
AU - Lortholary, Olivier
AU - Wang, Duolao
AU - Jaffar, Shabbar
AU - Loyse, Angela
AU - Heyderman, Robert S.
AU - Harrison, Thomas S.
AU - Molloy, Síle F.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - BackgroundAn increasing proportion of patients with HIV-associated cryptococcal meningitis have received antiretroviral therapy (ART) prior to presentation. There is some evidence suggesting an increased two-week mortality in those receiving ART for less than 14 days compared with those on ART for more than 14 days. However, presentation and outcomes for cryptococcal meningitis patients who have recently initiated ART, and those with virologic failure and/or non-adherence are not well described.Methods678 adults with first episode of cryptococcal meningitis recruited into a randomized, non-inferiority, multicentre phase 3 trial in 4 sub-Saharan countries were analysed to compare clinical presentation and 2-and 10-week mortality outcomes between ART-naive and experienced patients, and between patients receiving ART for varying durations prior to presentation.ResultsOver half (56% (381/678)) the study participants diagnosed with a first episode of cryptococcal meningitis were ART-experienced. All-cause mortality was similar at 2-weeks (17% vs 20%; HR 0.85, 95%CI 0.6-1.2, p=0.35), and 10 weeks (38% vs 36%; HR 1.03, 95%CI 0.8-1.32, p=0.82) for ART-experienced vs ART-naïve patients, respectively. Among ART-experienced patients, using different cut-off points for ART duration, there were no significant differences in 2- and 10-week mortality based on duration of ART.ConclusionIn this study, there were no significant differences in mortality at 2-and 10-weeks between ART- naive and experienced patients, and between ART-experienced patients according to duration on ART.
AB - BackgroundAn increasing proportion of patients with HIV-associated cryptococcal meningitis have received antiretroviral therapy (ART) prior to presentation. There is some evidence suggesting an increased two-week mortality in those receiving ART for less than 14 days compared with those on ART for more than 14 days. However, presentation and outcomes for cryptococcal meningitis patients who have recently initiated ART, and those with virologic failure and/or non-adherence are not well described.Methods678 adults with first episode of cryptococcal meningitis recruited into a randomized, non-inferiority, multicentre phase 3 trial in 4 sub-Saharan countries were analysed to compare clinical presentation and 2-and 10-week mortality outcomes between ART-naive and experienced patients, and between patients receiving ART for varying durations prior to presentation.ResultsOver half (56% (381/678)) the study participants diagnosed with a first episode of cryptococcal meningitis were ART-experienced. All-cause mortality was similar at 2-weeks (17% vs 20%; HR 0.85, 95%CI 0.6-1.2, p=0.35), and 10 weeks (38% vs 36%; HR 1.03, 95%CI 0.8-1.32, p=0.82) for ART-experienced vs ART-naïve patients, respectively. Among ART-experienced patients, using different cut-off points for ART duration, there were no significant differences in 2- and 10-week mortality based on duration of ART.ConclusionIn this study, there were no significant differences in mortality at 2-and 10-weeks between ART- naive and experienced patients, and between ART-experienced patients according to duration on ART.
KW - Antiretroviral therapy
KW - Cryptococcal meningitis
KW - HIV
KW - Short-term mortality
KW - Sub-Saharan Africa
U2 - 10.1093/ofid/ofab397
DO - 10.1093/ofid/ofab397
M3 - Article
SN - 2328-8957
VL - 8
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 10
M1 - ofab397
ER -
