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Kalata N, Ellis J, Kanyama C, et al. Short-term Mortality Outcomes of HIV-Associated Cryptococcal Meningitis in Antiretroviral Therapy-Naïve and -Experienced Patients in Sub-Saharan Africa. Open Forum Infect Dis. 2021;8(10):ofab397doi: 10.1093/ofid/ofab397.
Kalata, N., Ellis, J., Kanyama, C., Kuoanfank, C., Temfack, E., Mfinanga, S., Lesikari, S., Chanda, D., Lakhi, S., Nyazika, T., Chan, A. K., van Oosterhout, J. J., Chen, T., Hosseinipour, M. C., Lortholary, O., Wang, D., Jaffar, S., Loyse, A., Heyderman, R. S., Harrison, T. S., & Molloy, S. F. (2021). Short-term Mortality Outcomes of HIV-Associated Cryptococcal Meningitis in Antiretroviral Therapy-Naïve and -Experienced Patients in Sub-Saharan Africa. Open forum infectious diseases, 8(10), ofab397. https://doi.org/10.1093/ofid/ofab397
Kalata, Newton, et al. "Short-term Mortality Outcomes of HIV-Associated Cryptococcal Meningitis in Antiretroviral Therapy-Naïve and -Experienced Patients in Sub-Saharan Africa." Open forum infectious diseases vol. 8,10 (2021): ofab397. doi: https://doi.org/10.1093/ofid/ofab397
Kalata N, Ellis J, Kanyama C, Kuoanfank C, Temfack E, Mfinanga S, Lesikari S, Chanda D, Lakhi S, Nyazika T, Chan AK, van Oosterhout JJ, Chen T, Hosseinipour MC, Lortholary O, Wang D, Jaffar S, Loyse A, Heyderman RS, Harrison TS, Molloy SF. Short-term Mortality Outcomes of HIV-Associated Cryptococcal Meningitis in Antiretroviral Therapy-Naïve and -Experienced Patients in Sub-Saharan Africa. Open Forum Infect Dis. 2021 Jul 28;8(10):ofab397. doi: 10.1093/ofid/ofab397. eCollection 2021 Oct. PMID: 34646905; PMCID: PMC8501291.
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Open Forum Infect Dis. 2021 Jul 28;8(10):ofab397. doi: 10.1093/ofid/ofab397. eCollection 2021 Oct.

Short-term Mortality Outcomes of HIV-Associated Cryptococcal Meningitis in Antiretroviral Therapy-Naïve and -Experienced Patients in Sub-Saharan Africa.

Open forum infectious diseases

Newton Kalata, Jayne Ellis, Cecilia Kanyama, Charles Kuoanfank, Elvis Temfack, Sayoki Mfinanga, Sokoine Lesikari, Duncan Chanda, Shabir Lakhi, Tinashe Nyazika, Adrienne K Chan, Joep J van Oosterhout, Tao Chen, Mina C Hosseinipour, Olivier Lortholary, Duolao Wang, Shabbar Jaffar, Angela Loyse, Robert S Heyderman, Thomas S Harrison, Síle F Molloy

Affiliations

  1. Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  2. Division of Infection and Immunity, University College London, London, UK.
  3. University of North Carolina Project, Kamuzu Central Hospital, Lilongwe, Malawi.
  4. University of Dschang, Dschang, Cameroon.
  5. Douala General Hospital, Douala, Cameroon.
  6. Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania.
  7. University Teaching Hospital, Lusaka, Zambia.
  8. Dignitas International, Zomba Central Hospital, Zomba, Malawi.
  9. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  10. Liverpool School of Tropical Medicine, Liverpool, UK.
  11. Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
  12. Centre for Global Health, Institute of Infection and Immunity, St George University of London, London, UK.
  13. MRC Centre for Medical Mycology, University of Exeter, Exeter, UK.

PMID: 34646905 PMCID: PMC8501291 DOI: 10.1093/ofid/ofab397

Abstract

BACKGROUND: An increasing proportion of patients with HIV-associated cryptococcal meningitis have received antiretroviral therapy (ART) before presentation. There is some evidence suggesting an increased 2-week mortality in those receiving ART for <14 days compared with those on ART for >14 days. However, presentation and outcomes for cryptococcal meningitis patients who have recently initiated ART, and those with virologic failure and/or nonadherence, are not well described.

METHODS: Six hundred seventy-eight adults with a first episode of cryptococcal meningitis recruited into a randomized, noninferiority, multicenter phase 3 trial in 4 Sub-Saharan countries were analyzed to compare clinical presentation and 2- and 10-week mortality outcomes between ART-naïve and -experienced patients and between patients receiving ART for varying durations before presentation.

RESULTS: Over 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%; hazard ratio [HR], 0.85; 95% CI, 0.6-1.2;

CONCLUSIONS: In this study, there were no significant differences in mortality at 2 and 10 weeks between ART-naïve and -experienced patients and between ART-experienced patients according to duration on ART.

© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords: Antiretroviral therapy; Cryptococcal meningitis; HIV; Short-term mortality; Sub-Saharan Africa

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