The Use of HAART Is Associated With Decreased Risk of Death During Initial Treatment of Cryptococcal Meningitis in Adults in Botswana

Abstract

Objective The objective of this study was to evaluate outcomes among adults with a first episode of cryptococcal meningitis (CM), comparing those on highly active antiretroviral therapy (HAART) with those not on HAART. Methods We conducted a prospective cohort study among HIV-infected adults (aged 18 years and older) with a first episode of CM at the Princess Marina Hospital, in Gaborone, Botswana. The proportions surviving to discharge were compared. Logistic regression was used to evaluate the relationship between HAART use and risk of death in the hospital, adjusting for potential confounders. Results Ninety-two patients [median CD4 41 cells/mm3 (inter-quartile range 22–85)] were included, 26 of whom were on HAART at the time that they developed CM. The in-hospital mortality was lower among those on HAART {2 of 26 (8%) vs 14 of 66 (21%); odds ratio = 0.36 [95% confidence interval (CI) 0.09 to 1.49]}, and this result was statistically significant after adjustment for male sex and tuberculosis [adjusted odds ratio = 0.19 (95% CI 0.04 to 1.00)]. Conclusions HAART use at the time of a first admission with CM is associated with decreased risk of death during the acute phase of disease. Reasons for this association should be explored.

Cryptoccocal meningitis and HIV in the era of HAART in Côte d’Ivoire

“…Makadzange et al recently published results supporting our regimen; indeed, they reported that mortality was three times higher when ARV was initiated in the first 15 days following antifungal treatment initiation [31]. The risk to present with IRIS, when ARV is initiated early, is increased if a patient presents with severe immunodepression, is naive of ARV, and has a high fungal load [2,3,19,32]. The death rate in our study was significantly lower than in Sub-Saharan African studies in which it ranged between 70 and 80% [11][12][13].…”

“…Despite the above-mentioned limitations, our results correlate to the Botswana study on 92 patients, in which the authors noted the beneficial impact of ARV on the hospital outcome of patients. (8% versus 21%; OR: 0.36; 95% CI: 0.09-1.49) [32]. In any case, other prospective studies on cryptococcal meningitis in the Ivory Coast are needed to confirm these trends.…”

Management of Cryptococcal Meningitis in Sub-Saharan Africa

“…Survival among patients with a first diagnosis of CM was improved among patients who were on ART prior to the time of the diagnosis. However, this nonrandomized study does not address the optimal timing of ART [36]. A randomized study that included over 30 CM patients receiving AmB therapy compared starting ART within 2 weeks versus after initial treatment gave a (nonsignificant) trend toward more favorable outcome with earlier treatment [37].…”

Ocular complications of HIV infection in sub-Sahara Africa

“…The in-patient case-fatality rate in Gaborone between 2005 and 2006 was 20%. The case-fatality rate was lower in patients who were on HAART on admission compared with those who were not: 2 in 26 (2%) versus 14 in 66 (21%) [ 37 ].…”