| Abstract | OBJECTIVE: To study survival time and risk factors of mortality among HIV-infected patients who had cryptococcal meningitis. DESIGN: Retrospective cohort study. MATERIAL AND METHOD: Patients' medical records of those who had HIV-infection with newly diagnosed cryptoccocal meningitis between January 2002 and December 2004 were reviewed. Each patient was classified into one of two groups, according to their anti-retroviral status (ART). RESULTS: Five hundred and forty nine patients enrolled in the present study: 281 (51.2%) in the ART+ group and 268 (48.8%) in the ART-group. The mean age was 33.4 +/- 6.9 years old in the ART + group and 33.6 +/- 7.0 years old in the ART-group. There were more male in both groups: 207 males and 74 females in the ART+ group, and 195 males and 73 females in the ART-group. Baseline CD4 cell count of both groups was 20 (6-74) cells/mL and 24 (9-72) cells/ml. About 30% of both groups of patients experienced major opportunistic infection before cryptococcal meningitis. All patients were treated by standard amphotericin B for a 2-week duration followed by fluconazole for an additional 8 weeks. There were no differences of baseline characteristics between the two groups (p > 0.05). The survival rates at 12, 24, and 36 months were 92.8%, 87.4%, and 85.4% in the ART+ group and 55.3%, 42.2%, and 36.8% in the ART- group, respectively (p < 0.01). The median survival time in the ART- group was 15 months. From the Cox regression model, the hazard ratio for "not received ART" was 4.87 (95%CI = 2.48-9.44, p < 0.01). CONCLUSION: The present study demonstrated the substantial increasing of survival time of HIV-infected patients with cryptococcal meningitis by initiated ART even in a resource limited setting (no flucytosine, local combined antiretroviral drugs with NVP based regimens). |
| Authors | Suthat Chottanapund, Pratap Singhasivanon, Jaranit Kaewkungwal, Kanittha Chamroonswasdi, Weerawat Manosuthi
(Affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. suthat_97 at yahoo.com)
|
| Journal | Journal of the Medical Association of Thailand = Chotmaihet thangphaet
(J Med Assoc Thai)
Vol. 90
Issue 10
Pg. 2104-11
(Oct 2007)
ISSN: 0125-2208 Thailand |
| PMID | 18041430
(Publication Type: Journal Article)
|
| Chemical References |
- Anti-Bacterial Agents
- Amphotericin B
- Fluconazole
|
| Topics |
- Adult
- Amphotericin B
(therapeutic use)
- Anti-Bacterial Agents
(therapeutic use)
- CD4 Lymphocyte Count
- Comorbidity
- Female
- Fluconazole
(therapeutic use)
- HIV Infections
(drug therapy, mortality)
- Humans
- Male
- Meningitis, Cryptococcal
(drug therapy, mortality)
- Retrospective Studies
- Risk Factors
- Survival
- Time Factors
|
