Publication: Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: implications for improving outcomes.
Accepted Date
2013-11-21
Issued Date
2014-03
Copyright Date
2013
Resource Type
Language
eng
ISSN
1058-4838 (printed)
1537-6591 (electronic)
1537-6591 (electronic)
Rights
Mahidol University
Rights Holder(s)
Clinical Infectious Diseases
Bibliographic Citation
Jarvis JN, Bicanic T, Loyse A, Namarika D, Jackson A, Nussbaum JC. et al. Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: implications for improving outcomes. Clin Infect Dis. 2014 Mar;58(5):736-45.
Suggested Citation
Jarvis, Joseph N., Bicanic, Tihana, Loyse, Angela, Namarika, Daniel, Jackson, Arthur, Nussbaum, Jesse C., Longley, Nicky, Muzoora, Conrad, Phulusa, Jacob, Taseera, Kabanda, Kanyembe, Creto, Wilson, Douglas, Hosseinipour, Mina C., Brouwer, Annemarie E., Direk Limmathurotsakul,, ดิเรก ลิ้มมธุรสกุล, White, Nicholas, van der Horst, Charles, Wood, Robin, Meintjes, Graeme, Bradley, John, Jaffar, Shabbar, Harrison, Thomas Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: implications for improving outcomes.. Jarvis JN, Bicanic T, Loyse A, Namarika D, Jackson A, Nussbaum JC. et al. Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: implications for improving outcomes. Clin Infect Dis. 2014 Mar;58(5):736-45.. doi:10.1093/cid/cit794. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/840
Research Projects
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Title
Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: implications for improving outcomes.
Author(s)
Jarvis, Joseph N.
Bicanic, Tihana
Loyse, Angela
Namarika, Daniel
Jackson, Arthur
Nussbaum, Jesse C.
Longley, Nicky
Muzoora, Conrad
Phulusa, Jacob
Taseera, Kabanda
Kanyembe, Creto
Wilson, Douglas
Hosseinipour, Mina C.
Brouwer, Annemarie E.
Direk Limmathurotsakul,
ดิเรก ลิ้มมธุรสกุล
White, Nicholas
van der Horst, Charles
Wood, Robin
Meintjes, Graeme
Bradley, John
Jaffar, Shabbar
Harrison, Thomas
Bicanic, Tihana
Loyse, Angela
Namarika, Daniel
Jackson, Arthur
Nussbaum, Jesse C.
Longley, Nicky
Muzoora, Conrad
Phulusa, Jacob
Taseera, Kabanda
Kanyembe, Creto
Wilson, Douglas
Hosseinipour, Mina C.
Brouwer, Annemarie E.
Direk Limmathurotsakul,
ดิเรก ลิ้มมธุรสกุล
White, Nicholas
van der Horst, Charles
Wood, Robin
Meintjes, Graeme
Bradley, John
Jaffar, Shabbar
Harrison, Thomas
Corresponding Author(s)
Other Contributor(s)
Abstract
BACKGROUND: Cryptococcal meningitis (CM) is a leading cause of death in
individuals infected with human immunodeficiency virus (HIV). Identifying factors
associated with mortality informs strategies to improve outcomes.
METHODS: Five hundred one patients with HIV-associated CM were followed
prospectively for 10 weeks during trials in Thailand, Uganda, Malawi, and South
Africa. South African patients (n = 266) were followed for 1 year. Similar
inclusion/exclusion criteria were applied at all sites. Logistic regression
identified baseline variables independently associated with mortality.
RESULTS: Mortality was 17% at 2 weeks and 34% at 10 weeks. Altered mental status
(odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7-5.9), high cerebrospinal
fluid (CSF) fungal burden (OR, 1.4 per log10 colony-forming units/mL increase;
95% CI, 1.0-1.8), older age (>50 years; OR, 3.9; 95% CI, 1.4-11.1), high
peripheral white blood cell count (>10 × 10(9) cells/L; OR, 8.7; 95% CI,
2.5-30.2), fluconazole-based induction treatment, and slow clearance of CSF
infection were independently associated with 2-week mortality. Low body weight,
anemia (hemoglobin <7.5 g/dL), and low CSF opening pressure were independently
associated with mortality at 10 weeks in addition to altered mental status, high
fungal burden, high peripheral white cell count, and older age. In those followed
for 1 year, overall mortality was 41%. Immune reconstitution inflammatory
syndrome occurred in 13% of patients and was associated with 2-week CSF fungal
burden (P = .007), but not with time to initiation of antiretroviral therapy
(ART).
CONCLUSIONS: CSF fungal burden, altered mental status, and rate of clearance of
infection predict acute mortality in HIV-associated CM. The results suggest that
earlier diagnosis, more rapidly fungicidal amphotericin-based regimens, and
prompt immune reconstitution with ART are priorities for improving outcomes.