TY - JOUR
T1 - Treatment of cryptococcal meningitis in KwaZulu-Natal, South Africa
AU - Lightowler, Josephine V.J.
AU - Cooke, Graham S.
AU - Mutevedzi, Portia
AU - Lessells, Richard J.
AU - Newell, Marie Louise
AU - Dedicoat, Martin
PY - 2010/1/7
Y1 - 2010/1/7
N2 - Background: Cryptococcal meningitis (CM) remains a leading cause of death for HIV-infected individuals in sub-Saharan Africa. Improved treatment strategies are needed if individuals are to benefit from the increasing availability of antiretroviral therapy. We investigated the factors associated with mortality in routine care in KwaZulu-Natal, South Africa. Methodology/Principal Findings:A prospective year long, single-center, consecutive case series of individuals diagnosed with cryptococcal meningitis 190 patients were diagnosed with culture positive cryptococcal meningitis, of whom 186 were included in the study. 52/186 (28.0%) patients died within 14 days of diagnosis and 60/186 (32.3%) had died by day 28. In multivariable cox regression analysis, focal neurology (aHR 11 95%C.I. 3.08-39.3, P<0.001), diastolic blood pressure <60 mmHg (aHR 2.37 95%C.I. 1.11-5.04, P = 0.025), concurrent treatment for tuberculosis (aHR 2.11 95%C.I. 1.02-4.35, P = 0.044) and use of fluconazole monotherapy (aHR 3.69 95% C.I. 1.74-7.85, P<0.001) were associated with increased mortality at 14 and 28 days. Conclusions: Even in a setting where amphotericin B is available, mortality from cryptococcal meningitis in this setting is high, particularly in the immediate period after diagnosis. This highlights the still unmet need not only for earlier diagnosis of HIV and timely access to treatment of opportunistic infections, but for better treatment strategies of cryptococcal meningitis.
AB - Background: Cryptococcal meningitis (CM) remains a leading cause of death for HIV-infected individuals in sub-Saharan Africa. Improved treatment strategies are needed if individuals are to benefit from the increasing availability of antiretroviral therapy. We investigated the factors associated with mortality in routine care in KwaZulu-Natal, South Africa. Methodology/Principal Findings:A prospective year long, single-center, consecutive case series of individuals diagnosed with cryptococcal meningitis 190 patients were diagnosed with culture positive cryptococcal meningitis, of whom 186 were included in the study. 52/186 (28.0%) patients died within 14 days of diagnosis and 60/186 (32.3%) had died by day 28. In multivariable cox regression analysis, focal neurology (aHR 11 95%C.I. 3.08-39.3, P<0.001), diastolic blood pressure <60 mmHg (aHR 2.37 95%C.I. 1.11-5.04, P = 0.025), concurrent treatment for tuberculosis (aHR 2.11 95%C.I. 1.02-4.35, P = 0.044) and use of fluconazole monotherapy (aHR 3.69 95% C.I. 1.74-7.85, P<0.001) were associated with increased mortality at 14 and 28 days. Conclusions: Even in a setting where amphotericin B is available, mortality from cryptococcal meningitis in this setting is high, particularly in the immediate period after diagnosis. This highlights the still unmet need not only for earlier diagnosis of HIV and timely access to treatment of opportunistic infections, but for better treatment strategies of cryptococcal meningitis.
UR - http://www.scopus.com/inward/record.url?scp=77649168730&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0008630
DO - 10.1371/journal.pone.0008630
M3 - Article
C2 - 20062814
AN - SCOPUS:77649168730
SN - 1932-6203
VL - 5
JO - PLoS ONE
JF - PLoS ONE
IS - 1
M1 - e8630
ER -