TITLE

Incidence, clinical presentation, and outcome of HIV-1-associated cryptococcal meningitis during the highly active antiretroviral therapy era: a nationwide cohort study

AUTHOR(S)
Touma, Madeleine; Rasmussen, Line D.; Martin-Iguacel, Raquel; Engsig, Frederik Neess; Stærke, Nina Breinholt; Stærkind, Mette; Obel, Niels; Ahlström, Magnus Glindvad
PUB. DATE
July 2017
SOURCE
Clinical Epidemiology;Jul2017, Vol. 9, p385
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Human immunodeficiency virus (HIV) infection with advanced immunosuppression predisposes to cryptococcal meningitis (CM). We describe the incidence, clinical presentation, and outcome of CM in HIV-infected individuals during the highly active antiretroviral therapy (HAART) era. Methods: A nationwide, population-based cohort of HIV-infected individuals was used to estimate incidence and mortality of CM including risk factors. A description of neurological symptoms of CM at presentation and follow-up in the study period 1995-2014 was included in this study. Results: Among 6,351 HIV-infected individuals, 40 were diagnosed with CM. The incidence rates were 3.7, 1.8, and 0.3 per 1000 person-years at risk in 1995-1996, 1997-1999, and 2000-2014, respectively. Initiation of HAART was associated with decreased risk of acquiring CM [incidence rate ratio (IRR), 0.1 (95% CI, 0.05-0.22)]. African origin was associated with increased risk of CM [IRR, 2.05 (95% CI, 1.00-4.20)]. The main signs and symptoms at presentation were headache, cognitive deficits, fever, neck stiffness, nausea, and vomiting. All individuals diagnosed with CM had a CD4+ cell count <200 cells/μl [median 26; interquartile range (IQR), 10-50)]. Overall, mortality following CM was high and mortality in the first 4 months has not changed substantially over time. However, individuals who survived generally had a favorable prognosis, with 86% (18/21) returning to the pre-CM level of activity. Conclusion: The incidence of HIV-associated CM has decreased substantially after the introduction of HAART. To further decrease CM incidence and associated mortality, early HIV diagnosis and HAART initiation seems crucial.
ACCESSION #
124422884

 

Related Articles

  • Cohort profile: the Chinese national free antiretroviral treatment cohort. Ye Ma; Fujie Zhang; Yan Zhao; Chunpeng Zang; Decai Zhao; Zhihui Dou; Lan Yu; Hua Fang; Zhu, Timothy Y.; Chen, Ray Y.; Ma, Ye; Zhang, Fujie; Zhao, Yan; Zang, Chunpeng; Zhao, Decai; Dou, Zhihui; Yu, Lan; Fang, Hua // International Journal of Epidemiology;Aug2010, Vol. 39 Issue 4, p973 

    The article discusses the free antiretroviral therapy (ART) program in China which provides human immunodeficiency virus (HIV) treatment and care to rural and low-income urban patients who meet the guidelines. According to an observational cohort in 2004, the ART for adults is studied based on...

  • Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: A cohort study. Naho Tsuchiya; Panita Pathipvanich; Nuanjun Wichukchinda; Archawin Rojanawiwat; Wattana Auwanit; Koya Ariyoshi; Pathom Sawanpanyalert // BMC Infectious Diseases;2014, Vol. 14 Issue 1, p1 

    Background Antiretroviral therapy markedly reduced mortality in HIV-infected individuals. However, in the previous studies, up to 50% of patients are compelled to modify their regimen in middle and low-income countries where salvage drug is still limited. This cohort study aimed to investigate...

  • Valproic acid is associated with cognitive decline in HIV-infected individuals: a clinical observational study. Cysique, Lucette A.; Maruff, Paul; Brew, Bruce J. // BMC Neurology;2006, Vol. 6, p42 

    Background: Valproic acid (VPA) is often used to control pain in HIV-related neuropathy. However, the effect of VPA on cognitive functions in advanced HIV-infected individuals is largely unknown. A recent study would suggest that it may have a neuroprotective effect, the doses used were low and...

  • Self-Reported Symptoms Among HIV-lnfected Patients on Highly Active Antiretroviral Therapy in the ATHENA Cohort in The Netherlands. de Boer, I. Marion; Prins, Jan M.; Sprangers, Mirjam A.G.; Smit, Colette; Nieuwkerk, Pythia T. // HIV Clinical Trials;May/Jun2011, Vol. 12 Issue 3, p161 

    Background: HIV-infected patients on combination antiretroviral therapy (cART) may experience symptoms because of HIV disease or treatment. Symptoms might negatively affect quality of life, adherence, virological response, and survival. We investigated to what extent HIV-infected patients...

  • Rates and Reasons for Early Change of First HAART in HIV-1-Infected Patients in 7 Sites throughout the Caribbean and Latin America. Cesar, Carina; Shepherd, Bryan E.; Krolewiecki, Alejandro J.; Fink, Valeria I.; Schechter, Mauro; Tuboi, Suely H.; Wolff, Marcelo; Pape, Jean W.; Leger, Paul; Padgett, Denis; Madero, Juan Sierra; Gotuzzo, Eduardo; Sued, Omar; McGowan, Catherine C.; Masys, Daniel R.; Cahn, Pedro E. // PLoS ONE;2010, Vol. 5 Issue 6, p1 

    Background: HAART rollout in Latin America and the Caribbean has increased from approximately 210,000 in 2003 to 390,000 patients in 2007, covering 62% (51%-70%) of eligible patients, with considerable variation among countries. No multi-cohort study has examined rates of and reasons for change...

  • Changes in Advanced Immunosuppression and Detectable HIV Viremia Among Perinatally HIV-Infected Youth in the Multisite United States HIV Research Network. Agwu, Allison L.; Fleishman, John A.; Rutstein, Richard; Korthuis, P. Todd; Gebo, Kelly // Journal of the Pediatric Infectious Diseases Society;Sep2013, Vol. 2 Issue 3, p215 

    Background Due to successful antiretroviral therapy (ART), perinatally human immunodeficiency virus (PHIV)–infected children are reaching adolescence and young adulthood. Adolescence is characterized by factors (eg, increased risk-taking) that may hamper management. We examined...

  • Oral Candidosis in HIV-Infected Patients. Egusa, Hiroshi; Soysa, Niroshani S.; Ellepola, Arjuna N.; Yatani, Hirofumi; Samaranayake, Lakshman P. // Current HIV Research;Nov2008, Vol. 6 Issue 6, p485 

    Oral candidosis (syn. Oral candidiasis; OC), is a collective term given to a group of oral mucosal disorders caused by the fugal pathogen belonging to the genus Candida. The association of OC with the human immunodeficiency virus (HIV) infection has been known since the advent of the acquired...

  • Type I aortic dissection in a patient with human immunodeficiency virus infection. Yinzhong Shen; Wei Song; Hongzhou Lu // BioScience Trends;Jun2012, Vol. 6 Issue 3, p143 

    The use of highly active antiretroviral therapy in patients with HIV infection has significantly reduced HIV-related infectious complications and improved their survival. With effective antiretroviral therapy, cardiovascular disease has gained prominence as a cause of morbidity and mortality in...

  • High Prevalence of Echocardiographic Abnormalities among HIV-infected Persons in the Era of Highly Active Antiretroviral Therapy. Mondy, Kristin E.; Gottdiener, John; Overton, E. Turner; Henry, Keith; Bush, Tim; Conley, Lois; Hammer, John; Carpenter, Charles C.; Kojic, Erna; Patel, Pragna; Brooks, John T. // Clinical Infectious Diseases;Feb2011, Vol. 52 Issue 3, p378 

    A high prevalence of subclinical cardiac abnormalities was found by echocardiography in a large U.S. cohort of patients with generally well-controlled HIV. Abnormalities were often associated with expected and modifiable risk factors.Background. In the era of highly active antiretroviral therapy...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics