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Survival time of HIV-infected patients with cryptococcal meningitis.

AbstractOBJECTIVE:
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).
AuthorsSuthat Chottanapund, Pratap Singhasivanon, Jaranit Kaewkungwal, Kanittha Chamroonswasdi, Weerawat Manosuthi
JournalJournal of the Medical Association of Thailand = Chotmaihet thangphaet (J Med Assoc Thai) Vol. 90 Issue 10 Pg. 2104-11 (Oct 2007) ISSN: 0125-2208 [Print] Thailand
PMID18041430 (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

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