Predictors of poor clinical outcome of cryptococcal meningitis in HIV-infected patients

The aim of this study was to identify baseline prognostic factors for poor clinical outcome of HIV-associated cryptococcal meningitis. We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningiti...

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Bibliographic Details
Published in:International journal of STD & AIDS 2011-11, Vol.22 (11), p.665-670
Main Authors: Anekthananon, T, Manosuthi, W, Chetchotisakd, P, Kiertiburanakul, S, Supparatpinyo, K, Ratanasuwan, W, Pappas, P G, Filler, S G, Kopetskie, H A, Nolen, T L, Kendrick, A S, Larsen, R A
Format: Article
Language:English
Subjects:
AIDS/HIV
Amphotericin B - administration & dosage
Antifungal Agents - administration & dosage
Biological and medical sciences
Cerebrospinal Fluid - microbiology
Cryptococcus
Fluconazole - administration & dosage
General aspects
HIV Infections - complications
Human immunodeficiency virus
Human mycoses
Human viral diseases
Humans
Infectious diseases
Medical sciences
Meningitis, Cryptococcal - diagnosis
Meningitis, Cryptococcal - drug therapy
Meningitis, Cryptococcal - mortality
Meningitis, Cryptococcal - pathology
Miscellaneous mycoses
Mycoses
Prognosis
Survival Analysis
Thailand
Treatment Outcome
United States
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:The aim of this study was to identify baseline prognostic factors for poor clinical outcome of HIV-associated cryptococcal meningitis. We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningitis to amphotericin B followed by fluconazole. Subjects who were either alive and cerebrospinal fluid (CSF) culture-positive or dead were considered to have a poor outcome. At day 14, baseline characteristics associated with poor outcome included: low weight, high CSF cryptococcal antigen (CrAg) titre and low CSF white blood cell (WBC) count. At day 70, the associated baseline characteristics included: CSF CrAg titre >1:1024 and low Karnofsky performance status. Overall, consistent with published findings, low weight, high CSF CrAg titre and low CSF WBC counts at baseline were predictors for poor clinical outcome. In addition, we found that low Karnofsky performance status was predictive of poor outcome. Prompt management with appropriate antifungal therapy for this particular group of patients may improve the outcomes.
ISSN:0956-4624
1758-1052
DOI:10.1258/ijsa.2011.010538