dc.contributor.author | Person, Anna K. | |
dc.contributor.author | Crabtree-Ramirez, Brenda | |
dc.contributor.author | Kim, Ahra | |
dc.contributor.author | Veloso, Valdiléa | |
dc.contributor.author | Maruri, Fernanda | |
dc.contributor.author | Wandeler, Gilles | |
dc.contributor.author | Fox, Matthew | |
dc.contributor.author | Moore, Richard | |
dc.contributor.author | Gill, M. John | |
dc.contributor.author | Imran, Darma | |
dc.contributor.author | Nguyen, Kinh Van | |
dc.contributor.author | Nalitya, Elizabeth | |
dc.contributor.author | Muyindike, Winnie | |
dc.contributor.author | Shepherd, Bryan E. | |
dc.contributor.author | McGowan, Catherine C. | |
dc.date.accessioned | 2024-05-02T13:01:18Z | |
dc.date.available | 2024-05-02T13:01:18Z | |
dc.date.issued | 2023 | |
dc.identifier.citation | Person, A. K., Crabtree-Ramirez, B., Kim, A., Veloso, V., Maruri, F., Wandeler, G., ... & McGowan, C. C. (2023). Cryptococcal Meningitis and Clinical Outcomes in Persons With Human Immunodeficiency Virus: A Global View. Clinical Infectious Diseases, 76(12), 2116-2125. | en_US |
dc.identifier.uri | http://ir.must.ac.ug/xmlui/handle/123456789/3625 | |
dc.description.abstract | Background: Cryptococcal meningitis (CM) is a major cause of morbidity and mortality in persons with human immunodeficiency virus (HIV; PWH). Little is known about CM outcomes and availability of diagnostic and treatment modalities globally.
Methods: In this retrospective cohort study, we investigated CM incidence and all-cause mortality in PWH in the International Epidemiology Databases to Evaluate AIDS cohort from 1996 to 2017. We estimated incidence using quasi- Poisson models adjusted for sex, age, calendar year, CD4 cell count (CD4), and antiretroviral therapy (ART) status. Mortality after CM diagnosis was examined using multivariable Cox models. A site survey from 2017 assessed availability of CM diagnostic and treatment modalities.
Results: Among 518 852 PWH, there were 3857 cases of CM with an estimated incidence of 1.54 per 1000 person-years. Mortality over a median of 2.6 years of post-CM diagnosis follow-up was 31.6%, with 29% lost to follow-up. In total, 2478 (64%) were diagnosed with CM after ART start with a median of 253 days from ART start to CM diagnosis. Older age (hazard [HR], 1.31 for 50 vs 35 years), lower CD4 (HR, 1.15 for 200 vs 350 cells/mm3), and earlier year of CM diagnosis (HR, 0.51 for 2015 vs 2000) were associated with higher mortality. Of 89 sites, 34% reported access to amphotericin B; 12% had access to flucytosine.
Conclusions: Mortality after CM diagnosis was high. A substantial portion of CM cases occurred after ART start, though incidence and mortality may be higher than reported due to ascertainment bias. Many sites lacked access to recommended CM treatment. | en_US |
dc.description.sponsorship | National Institutes of Health’s (NIH’s) National Institute of Allergy and Infectious Diseases; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Cancer Institute; the National Institute of Mental Health; the National Institute on Drug Abuse; the National Heart, Lung, and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute of Diabetes and Digestive and Kidney Diseases; and the Fogarty International Center: Asia-Pacific, U01AI069907 | en_US |
dc.language.iso | en_US | en_US |
dc.publisher | Clinical Infectious Diseases | en_US |
dc.subject | HIV | en_US |
dc.subject | AIDS | en_US |
dc.subject | Cryptococcal meningitis | en_US |
dc.subject | Global health | en_US |
dc.title | Cryptococcal Meningitis and Clinical Outcomes in Persons With Human Immunodeficiency Virus: A Global Vie | en_US |
dc.type | Article | en_US |