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A pragmatic approach to managing antiretroviral therapy-experienced patients diagnosed with HIV-associated cryptococcal meningitis: impact of antiretroviral therapy adherence and duration.

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Alufandika, Melanie, Lawrence, David S, Boyer-Chammard, Timothée, Kanyama, Cecilia, Ndhlovu, Chiratidzo E, Mosepele, Mosepele, Tugume, Lillian, Meya, David, Boulware, David R, Rhein, Joshua, Muzoora, Conrad, Youssouf, Nabila, Molloy, Síle F, Schutz, Charlotte, Lortholary, Olivier, Meintjes, Graeme, Mwandumba, Henry ORCID: https://orcid.org/0000-0003-4470-3608, Harrison, Thomas S and Jarvis, Joseph N (2020) 'A pragmatic approach to managing antiretroviral therapy-experienced patients diagnosed with HIV-associated cryptococcal meningitis: impact of antiretroviral therapy adherence and duration.'. AIDS, Vol 34, Issue 9, pp. 1425-1428.

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Abstract

Cryptococcal meningitis accounts for 15% of all HIV-related deaths [1]. The overall number of cryptococcal meningitis cases has remained relatively stable in many low-to-middle income countries (LMICs) despite increasing roll-out of antiretroviral therapy (ART). Increasing numbers of patients are at risk of developing cryptococcal meningitis following ART failure or discontinuation, offsetting declines in those presenting for the first time with advanced HIV [2–4]. Over half of patients diagnosed with cryptococcal meningitis in recent studies in sub-Saharan Africa are ART-experienced (i.e. currently receiving or previously received ART) [5,6]. Although there is robust evidence from prospective randomized trials that ART initiation should be delayed until 4–6 weeks after starting antifungal therapy in ART-naïve cryptococcal meningitis patients [7,8], the approach to ART management among ART-experienced cryptococcal meningitis patients lacks adequate evidence, with a paucity of published data.

Item Type: Article
Subjects: WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
WL Nervous System > WL 200 Meninges. Blood-brain barrier
Faculty: Department: Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1097/QAD.0000000000002556
Depositing User: Julie Franco
Date Deposited: 08 Jul 2020 11:03
Last Modified: 16 Jul 2020 11:53
URI: https://archive.lstmed.ac.uk/id/eprint/14977

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