Outcome of HIV-1-associated cryptococcal meningitis, Denmark 1988-2008

TY - JOUR

T1 - Outcome of HIV-1-associated cryptococcal meningitis, Denmark 1988-2008

AU - Mathiesen, Inger Hee Mabuza

AU - Knudsen, Jenny Dahl

AU - Gerstoft, Jan

AU - Cowan, Susan

AU - Benfield, Thomas Lars Vibe

PY - 2012/3

Y1 - 2012/3

N2 - Introduction: The risk of HIV-1-associated Cryptococcus neoformans meningitis (CM) has decreased and the outcome has improved with the use of combination antiretroviral therapy (cART). Outcome has not been reported in Denmark in the cART era. Methods: A review of all cases of HIV-1-associated CM treated at 2 hospitals in Denmark was carried out. Survival was compared by time-updated Cox proportional hazards analysis. Results: A total of 45 cases were evaluated. Six individuals (13.3%) died within 30 days of being diagnosed with CM. cART was initiated a median of 15 days (range 353) after a diagnosis of CM for 12 individuals and did not affect 30-day outcome. Older age, however, was associated with an increased risk of death at 30 days (mortality rate ratio (MMR) 1.16 (95% confidence interval (95% CI) 1.051.30) per y increment). Twenty-four (55.8%) of 43 individuals (2 had emigrated) died within the 1 st y. Initiation of cART significantly improved 1-y outcome (MMR 0.22, 95% CI 0.060.77). Mental status, CD4 T cell count, and antifungal did not affect short- or long-term outcome. Conclusions: We found that long-term survival after HIV-1-associated CM has improved significantly with the use of cART. Short-term mortality was not affected by initiation of cART and remained high.

AB - Introduction: The risk of HIV-1-associated Cryptococcus neoformans meningitis (CM) has decreased and the outcome has improved with the use of combination antiretroviral therapy (cART). Outcome has not been reported in Denmark in the cART era. Methods: A review of all cases of HIV-1-associated CM treated at 2 hospitals in Denmark was carried out. Survival was compared by time-updated Cox proportional hazards analysis. Results: A total of 45 cases were evaluated. Six individuals (13.3%) died within 30 days of being diagnosed with CM. cART was initiated a median of 15 days (range 353) after a diagnosis of CM for 12 individuals and did not affect 30-day outcome. Older age, however, was associated with an increased risk of death at 30 days (mortality rate ratio (MMR) 1.16 (95% confidence interval (95% CI) 1.051.30) per y increment). Twenty-four (55.8%) of 43 individuals (2 had emigrated) died within the 1 st y. Initiation of cART significantly improved 1-y outcome (MMR 0.22, 95% CI 0.060.77). Mental status, CD4 T cell count, and antifungal did not affect short- or long-term outcome. Conclusions: We found that long-term survival after HIV-1-associated CM has improved significantly with the use of cART. Short-term mortality was not affected by initiation of cART and remained high.

U2 - 10.3109/00365548.2011.611168

DO - 10.3109/00365548.2011.611168

M3 - Journal article

C2 - 22077922

SN - 2374-4235

VL - 44

SP - 197

EP - 200

JO - Infectious Diseases

JF - Infectious Diseases

IS - 3

ER -