Clinical outcomes of cryptococcal meningitis among HIV-infected patients in the era of antiretroviral therapy

Cryptococcal meningitis (CM) is a common opportunistic infection in HIV-infected patients and the clinical outcome can be severe. This study aimed to determine the survival rate and prognostic factors among HIV-infected patients with CM in the era of antiretroviral therapy (ART). Understanding of these facts may help clinicians to manage CM patients efficiently and patients with poor prognostic factors could be closely monitored. We conducted a retrospective cohort study among new cases of HIV-associated CM who were treated at Ramathibodi Hospital, Mahidol University, Thailand, during 2002-2013. Of 195 patients, 119 (61%) were male; the median (interquartile range, IQR) age was 33 (29-39) years. The median (IQR) CD4 cell count was 20 (9-44) cells/mm³. The median survival time was >12 years and the 75% survival time was 5 years. Using the Cox proportional hazard model, the factors associated with mortality were impaired consciousness [hazard ratio (HR)=2.38; 95% confidence interval (CI): 1.03-5.50], low initial cerebrospinal fluid (CSF) protein (≤60 mg/dl) (HR=2.88; 95%CI: 1.13-7.35), low initial CSF glucose (≤30 mg/dl) (HR=2.36; 95%CI: 1.01-5.51), high opening pressure during induction therapy (>25 cmH₂O) (HR=2.90, 95%CI: 1.21-6.94), no ART (HR=14.8; 95%CI: 5.39-40.7) and relapse of CM (HR=4.31; 95%CI: 1.42-13.1). The HIV-associated CM survival rate in the ART era is higher than it was during the pre-ART era.