Outcomes of a 24-month study of patients with HIV with Cryptococcal meningitis on high-dose fluconazole induction in Abidjan, Côte d'Ivoire, between 2012 and 2016

TL;DR

A 24-month study in Côte d'Ivoire found poor long-term outcomes for HIV patients with cryptococcal meningitis treated with high-dose fluconazole.

Contribution

The study provides insights into long-term survival and mortality factors for HIV patients with cryptococcal meningitis in resource-limited settings.

Findings

High loss to follow-up rate after initial antifungal treatment.

Most deaths occurred within the first 6 months of follow-up.

Abstract

•High loss to follow-up rate after initial antifungal treatment.•Most deaths occurred within the first 6 months of follow-up.•Relapses of cryptococcal meningitis were the main cause of death.•Strengthening therapeutic education is necessary to improve the long-term prognosis.

High loss to follow-up rate after initial antifungal treatment.

Most deaths occurred within the first 6 months of follow-up.

Relapses of cryptococcal meningitis were the main cause of death.

Strengthening therapeutic education is necessary to improve the long-term prognosis.

Cryptococcal meningitis (CM) is a common cause of meningitis in patients with AIDS in sub-Saharan Africa, with a mortality rate of over 50% at 10 weeks. The preferred treatment in resource-limited countries without access to amphotericin B or 5-fluorocytosine is high-dose fluconazole (FCZ). However, survival and factors associated with mortality after completion of FCZ-based treatment are not well known. To assess the outcomes at 24 months of patients with HIV with CM who have completed the initial FCZ treatment.

Retrospective cohort study of adult patients with HIV with CM on oral FCZ 1200 mg/day induction, having completed 10 weeks of specific treatment between January 2012 and December 2016. The survival probability (not lost to follow-up or death) at 24 months was determined and the risk factors associated with death were identified using the Cox proportional hazard model.

Thirty-one (31) patients were enrolled from a total of 82. The median age was 42 years (38-44). Overall, 58% of the patients were female (n = 18) and 50% (14/28) were antiretroviral therapy experienced. The following outcomes were observed after 24 months of follow-up: 13 patients (41.9%) were lost to follow-up, 12 (38.7%) were still alive, 6 (19.3%) died, and 5 (16.1%) relapsed. The mortality rate was reduced by 77% where the clusters of differentiation 4 count was less than 100 cells/mm3, with adjustments for length of hospitalization and history of morbidities.

Long-term survival among patients with HIV with CM was poor. Interventions to strengthen linkage to HIV treatment and care and continuation of secondary fluconazole prophylaxis are critical.

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