Journal
POSTGRADUATE MEDICAL JOURNAL
Volume 89, Issue 1048, Pages 73-77Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/postgradmedj-2012-130823
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Funding
- American Academy of Neurology Foundation Practice Research Training Fellowship
- Fogarty International Clinical Research Fellowship from the National Institutes of Health, Fogarty International Center through Vanderbilt University [5 R24 TW00798, 3 R24 TW00798-02S1]
- National Cancer Institute (NCI)
- National Institute on Drug Abuse (NIDA), Office of the Director, National Institutes of Health
- National Institute of Mental Health (NIMH)
- [U62/CCU924511]
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Purpose Cryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines and determined predictors of survival. Design A computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005-2009. Medical records were reviewed. Kaplan-Meier survival curves were generated. Bivariate and multivariate Cox proportional hazards models were used to determine associations between key clinical characteristics and survival. Results Medical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR: 10-705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4 cell count, receipt of highly active antiretroviral therapy, and treatment with any anti-fungal therapy. Conclusions Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.
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