Short term mortality outcomes of HIV-associated Cryptococcal meningitis in antiretroviral therapy naïve and experienced patients in sub-Saharan Africa

Kalata, Newton, Ellis, Jayne, Kanyama, Cecilia, Kuoanfank, Charles, Temfack, Elvis, Mfinanga, Sayoki, Lesikari, Sokoine, Chanda, Duncan, Lakhi, Shabir, Nyazika, Tinashe, Chan, Adrienne K, van Oosterhout, Joep J, Chen, Tao ORCID: https://orcid.org/0000-0002-5489-6450, Hosseinipour, Mina C, Lortholary, Olivier, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Jaffar, Shabbar ORCID: https://orcid.org/0000-0002-9615-1588, Loyse, Angela, Heyderman, Robert S, Harrison, Thomas S and Molloy, Síle 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, Vol 8, Issue 10.

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Abstract

Background
An 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.

Methods
678 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.

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%; 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.

Conclusion
In 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.

Item Type:	Article
Subjects:	QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268.5 Antiviral agents (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WL Nervous System > WL 200 Meninges. Blood-brain barrier
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/ofid/ofab397
Depositing User:	Stacy Murtagh
Date Deposited:	06 Sep 2021 10:52
Last Modified:	10 Dec 2021 13:21
URI:	https://archive.lstmed.ac.uk/id/eprint/18832

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