Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings

Kendi, Caroline; Penner, Jeremy; Koech, Julius; Nyonda, Mary; Cohen, Craig R.; Bukusi, Elizabeth A.; Ngugi, Evelyn; Meyer, Ana Claire

doi:10.1136/postgradmedj-2012-130823

Cited by 15 publications

(13 citation statements)

References 27 publications

(28 reference statements)

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“…13,14 In addition, a low body mass index (BMI) has been shown previously to be an independent predictor of poor outcome. 15,16 As stated before, we did find a significantly higher mortality in patients presenting with nausea and vomiting. These symptoms could be indicative of a raised intracranial pressure, therefore, confirming the findings of the above-mentioned studies.…”

Section: Discussionsupporting

confidence: 73%

Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

et al. 2016

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Aim: This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with Cryptococcal meningitis (CM). These factors include the patient's socioeconomic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy.Methods: Data was collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed CM over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients' mortality risk. 2Results: 87 patients were identified. All except one were HIV positive, of which 55.2% were Antiretroviral Therapy (ART) naïve. A history of previous Tuberculosis (TB) was given by 25 patients (28.7%) and 49 (56.3%) were on TB treatment at admission or started during their hospital stay. In-hospital mortality was 31 %. Statistical analysis showed that ART naïve patients had 9.9 (CI 95% 1.2-81.2, p<0.0032) times greater odds of dying compared to those on ART, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment.Defaulters had 14.7 (CI 95% 1.6-131.6, p<0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7-23.1, p<0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for ART naïve patients and defaulters.Conclusion: CM is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting ART and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

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Section: Discussionsupporting

confidence: 73%

Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

et al. 2016

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“…Publication year of the included studies ranged from 2006 to 2019. The sample size of the included studies ranged from 71 in Kenya [ 95 ] to 68,378 in Tanzania [ 96 ]. Most were cohort studies ( n = 47, 88.7%).…”

Section: Resultsmentioning

confidence: 99%

Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis

et al. 2021

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Background Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA. Methods A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio. Results Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV. Conclusion This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings.

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“…We did not recommend different treatments for asymptomatic and minimally symptomatic patients because in our setting, even cryptococcal meningitis is treated primarily with fluconazole monotherapy (Kendi et al . ). Furthermore, in our setting, patients must pay for inpatient charges, while outpatient care and oral fluconazole are free.…”

Section: Methodsmentioning

confidence: 97%

The impact of routine cryptococcal antigen screening on survival among HIV‐infected individuals with advanced immunosuppression in Kenya

Meyer

Kendi

Penner

et al. 2013

Tropical Med Int Health

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Objectives We hypothesized that a screening and treatment intervention for early cryptococcal infection would improve survival among HIV-infected individuals with low CD4 cell counts. Methods Newly enrolled patients at Family AIDS Care and Education Services (FACES) in Kenya with CD4≤100 cells/μl were tested for serum Cryptococcal antigen (sCrAg). Individuals with sCrAg titer≥1:2 were treated with high-dose fluconazole. Cox proportional hazard models of Kaplan-Meier curves were used to compare survival among individuals with CD4≤100 cells/μl in the intervention and historical control groups. Results The median age was 34 years [IQR: 29,41], 54% were female, and median CD4 was 43 cells/μl [IQR: 18,71]. Follow-up time was 1224 person-years. In the intervention group 66% (514/782) were tested for sCrAg; of whom 11% (59/514) were sCrAg positive. Mortality was 25% (196/782) in the intervention group and 25% (191/771) in the control group. There was no significant difference between the intervention and control group in overall survival [Hazard Ratio(HR): 1.1 (95%CI:0.9,1.3)] or three-month survival [HR: 1.0 (95%CI:0.8,1.3)]. Within the intervention group, sCrAg positive individuals had borderline lower survival rates than sCrAg negative individuals [HR:1.8 (95%CI: 1.0, 3.0)]. Conclusions A screening and treatment intervention to identify sCrAg positive individuals and treat them with high-dose fluconazole did not significantly improve overall survival among HIV-infected individuals with CD4 counts≤100 cells/μl as compared to a historical control. Potential explanations include intervention uptake rates or poor efficacy of high-dose oral fluconazole. Future studies to identify the best treatments for early cryptococcal infection and improve uptake of the intervention are critical.

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Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings

Cited by 15 publications

References 27 publications

Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis

The impact of routine cryptococcal antigen screening on survival among HIV‐infected individuals with advanced immunosuppression in Kenya

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