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AIDS‐associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre‐ and post‐HAART eras. Experience of a single centre in Italy
Author(s) -
Antinori S,
Ridolfo AL,
Fasan M,
Magni C,
Galimberti L,
Milazzo L,
Sollima S,
Adorni F,
Giuliani G,
Galli M,
Corbellino M,
Parravicini C
Publication year - 2009
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2008.00645.x
Subject(s) - cryptococcosis , medicine , epidemiology , human immunodeficiency virus (hiv) , immune reconstitution inflammatory syndrome , antiretroviral therapy , immunology , pediatrics , viral load
Objectives To assess the prevalence, clinical and immunological characteristics, risk factors and survival of patients with AIDS‐related cryptococcosis in the era of highly active antiretroviral therapy (HAART). Methods All newly diagnosed cryptococcosis cases identified retrospectively from among a series of AIDS patients hospitalized consecutively at a single institution in Italy in 1985–1996 (pre‐HAART period, n =165) and 1997–2006 (post‐HAART period, n =40) were analysed comparatively. Results The prevalence of cryptococcosis decreased from 4.7% (165/3543) to 2.2% (40/1805) between the pre‐ and post‐HAART periods ( P =0.0001). There were no differences in the clinical features or immunological status of the patients between the two cohorts. The variables associated with the occurrence of cryptococcosis in the post‐HAART era were older age ( P <0.001), no previous diagnosis of HIV infection ( P <0.001) and infection in homosexual males ( P =0.004). During the post‐HAART period, immune reconstitution inflammatory syndrome associated with cryptococcosis was observed in five patients (19.3%) a median of 15 weeks after the start of HAART. Thirty‐day survival ( P =0.045) and overall survival ( P =0.0001) were significantly better among patients diagnosed with cryptococcosis in the post‐HAART compared to those diagnosed in the pre‐HAART era. Conclusions The AIDS‐associated cryptococcosis observed in Western countries in the HAART era has similar clinical and immunological characteristics to that observed in the pre‐HAART era, but a significantly better outcome.