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Cryptococcal meningitis in HIV‐infected patients: a longitudinal study in Cambodia
Author(s) -
Espié Emmanuelle,
Pinoges Loretxu,
Balkan Suna,
Chanchhaya Ngeth,
Molfino Lucas,
Narom Prak,
PujadesRodríguez Mar
Publication year - 2010
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02622.x
Subject(s) - cryptococcal meningitis , meningitis , human immunodeficiency virus (hiv) , medicine , sida , virology , environmental health , viral disease , pediatrics
Summary Objective To describe the frequency of diagnosis of cryptococcosis among HIV‐infected patients in Phnom Penh, Cambodia, at programme entry, to investigate associated risk factors, and to determine the incidence of cryptococcal meningitis. Methods We analysed individual monitoring data from 11 970 HIV‐infected adults enrolled between 1999 and 2008. We used Kaplan–Meier naïve methods to estimate survival and retention in care and multiple logistic regression to investigate associations with individual‐level factors. Results Cryptococcal meningitis was diagnosed in 12.0% of the patients: 1066 at inclusion and 374 during follow‐up. Incidence was 20.3 per 1000 person‐years and decreased over time. At diagnosis, median age was 33 years, median CD4 cell count was 8 cells/μl, and 2.4% of patients were receiving combined antiretroviral therapy; 38.7% died and 34.6% were lost to follow‐up. Of 750 patients alive and in care after 3 months of diagnosis, 85.9% received secondary cryptococcal meningitis prophylaxis and 13.7% relapsed in median 5.7 months [interquartile range 4.1–8.8] after cryptococcal meningitis diagnosis (relapse incidence = 5.7 per 100 person‐years; 95%CI 4.7–6.9). Cryptococcal meningitis was more common in men at programme entry (adjusted OR = 2.24, 95% CI 1.67–3.00) and fell with higher levels of CD4 cell counts ( P < 0.0001). Conclusions Cryptococcal meningitis remains an important cause of morbidity and mortality in Cambodian HIV‐infected patients. Our findings highlight the importance of increasing early access to HIV care and cryptococcal meningitis prophylaxis and of improving its diagnosis in resource‐limited settings.