dc.contributor.author | Tugume, Lillian | |
dc.contributor.author | Rhein, Joshua | |
dc.contributor.author | Hullsiek, Kathy Huppler | |
dc.contributor.author | Mpoza, Edward | |
dc.contributor.author | Kiggundu, Reuben | |
dc.contributor.author | Ssebambulidde, Kenneth | |
dc.contributor.author | Schutz, Charlotte | |
dc.contributor.author | Taseera, Kabanda | |
dc.contributor.author | Williams, Darlisha A. | |
dc.contributor.author | Abassi, Mahsa | |
dc.contributor.author | Muzoora, Conrad | |
dc.contributor.author | Musubire, Abdu K. | |
dc.contributor.author | Meintjes, Graeme | |
dc.contributor.author | Meya, David B. | |
dc.contributor.author | Boulware, David R. | |
dc.contributor.author | On behalf of COAT and ASTRO-CM teams | |
dc.date.accessioned | 2023-01-31T13:33:27Z | |
dc.date.available | 2023-01-31T13:33:27Z | |
dc.date.issued | 2019 | |
dc.identifier.citation | Tugume, L., Rhein, J., Hullsiek, K. H., Mpoza, E., Kiggundu, R., Ssebambulidde, K., ... & Boulware, D. R. (2019). HIV-associated cryptococcal meningitis occurring at relatively higher CD4 counts. The Journal of infectious diseases, 219(6), 877-883. | en_US |
dc.identifier.uri | http://ir.must.ac.ug/xmlui/handle/123456789/2734 | |
dc.description.abstract | Background: Cryptococcal meningitis can occur in persons with less-apparent immunosuppression. We evaluated clinical characteristics and outcomes of persons with HIV-related Cryptococcus presenting with higher CD4 counts.
Methods: We enrolled 736 participants from 2 prospective cohorts in Uganda and South Africa from November 2010 to May 2017. We compared participants with CD4 <50, 50–99, or ≥100 cells/μL by clinical characteristics, cerebrospinal fluid (CSF) parameters, and 18-week survival.
Result: Among first episode of cryptococcosis, 9% presented with CD4 ≥100 cells/μL. Participants with CD4 ≥100 cells/μL presented more often with altered mental status (52% vs 39%; P = .03) despite a 10-fold lower initial median CSF fungal burden of 7850 (interquartile range [IQR] 860–65 500) versus 79 000 (IQR 7400–380 000) colony forming units/mL (P < .001). Participants with CD4 ≥100 cells/μL had higher median CSF levels of interferon-gamma, interleukin (IL)-6, IL-8, and IL-13, and lower monocyte chemokine, CCL2 (P < .01 for each). Death within 18 weeks occurred in 47% with CD4 <50, 35% with CD4 50–99, and 40% with CD4 ≥100 cells/μL (P = .04).
Conclusion: HIV-infected individuals developing cryptococcal meningitis with CD4 ≥100 cells/μL presented more frequently with altered mental status despite having 10-fold lower fungal burden and with greater Th2 (IL-13) immune response. Higher CD4 count was protective despite an increased propensity for immune-mediated damage, consistent with damage-response framework | en_US |
dc.description.sponsorship | National Institute of Neurologic Diseases and Stroke (grant number R01NS086312); the Fogarty International Center (grant numbers
K01TW010268, R25TW009345); the National Institute of Allergy and Infectious Diseases (grant numbers T32AI055433, U01AI089244); | en_US |
dc.language.iso | en_US | en_US |
dc.publisher | The Journal of infectious diseases | en_US |
dc.subject | Cryptococcal meningitis | en_US |
dc.subject | CD4 T cells | en_US |
dc.subject | HIV | en_US |
dc.subject | CSF biomarkers | en_US |
dc.subject | AIDS | en_US |
dc.title | HIV-Associated Cryptococcal Meningitis Occurring at Relatively Higher CD4 Counts | en_US |
dc.type | Article | en_US |