Kalata, Newton; Ellis, Jayne; Kanyama, Cecilia; Kuoanfank, Charles; Temfack, Elvis; Mfinanga, Sayoki; Lesikari, Sokoine; Chanda, Duncan; Lakhi, Shabir; Nyazika, Tinashe; +11 more... Chan, Adrienne K; van Oosterhout, Joep J; Chen, Tao; Hosseinipour, Mina C; Lortholary, Olivier; Wang, Duolao; Jaffar, Shabbar; Loyse, Angela; Heyderman, Robert S; Harrison, Thomas S; Molloy, Síle F; (2021) Short-term Mortality Outcomes of HIV-Associated Cryptococcal Meningitis in Antiretroviral Therapy-Naïve and -Experienced Patients in Sub-Saharan Africa. Open forum infectious diseases, 8 (10). ofab397. ISSN 2328-8957 DOI: https://doi.org/10.1093/ofid/ofab397
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Abstract
BACKGROUND: An increasing proportion of patients with HIV-associated cryptococcal meningitis have received antiretroviral therapy (ART) before presentation. There is some evidence suggesting an increased 2-week mortality in those receiving ART for <14 days compared with those on ART for >14 days. However, presentation and outcomes for cryptococcal meningitis patients who have recently initiated ART, and those with virologic failure and/or nonadherence, are not well described. METHODS: Six hundred seventy-eight adults with a first episode of cryptococcal meningitis recruited into a randomized, noninferiority, multicenter phase 3 trial in 4 Sub-Saharan countries were analyzed to compare clinical presentation and 2- and 10-week mortality outcomes between ART-naïve and -experienced patients and between patients receiving ART for varying durations before presentation. RESULTS: Over half (56%; 381/678) the study participants diagnosed with a first episode of cryptococcal meningitis were ART-experienced. All-cause mortality was similar at 2 weeks (17% vs 20%; hazard ratio [HR], 0.85; 95% CI, 0.6-1.2; P = .35) and 10 weeks (38% vs 36%; HR, 1.03; 95% CI, 0.8-1.32; P = .82) for ART-experienced and ART-naïve patients. Among ART-experienced patients, using different cutoff points for ART duration, there were no significant differences in 2- and 10-week mortality based on duration of ART. CONCLUSIONS: In this study, there were no significant differences in mortality at 2 and 10 weeks between ART-naïve and -experienced patients and between ART-experienced patients according to duration on ART.
Item Type | Article |
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Faculty and Department | Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
PubMed ID | 34646905 |
Elements ID | 201923 |
Official URL | http://dx.doi.org/10.1093/ofid/ofab397 |
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Filename: Kalata-etal-2021-Short-term-mortality-outcomes-of-hiv-associated-cryptococcal-meningitis.pdf
Licence: Creative Commons: Attribution 4.0
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