Early mycological treatment failure in AIDS-associated cryptococcal meningitis.

Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Early mycological treatment failure in AIDS-associated cryptococcal meningitis.

Clin Infect Dis. 1999 Jan;28(1):82-92. Unique Identifier : AIDSLINE MED/99152402
Robinson PA; Bauer M; Leal MA; Evans SG; Holtom PD; Diamond DA; Leedom JM; Larsen RA; Department of Medicine, University of Southern California School; of Medicine, USA.

Abstract: Cryptococcal meningitis causes significant morbidity and mortality in persons with AIDS. Of 236 AIDS patients treated with amphotericin B plus flucytosine, 29 (12%) died within 2 weeks and 62 (26%) died before 10 weeks. Just 129 (55%) of 236 patients were alive with negative cerebrospinal fluid (CSF) cultures at 10 weeks. Multivariate analyses identified that titer of cryptococcal antigen in CSF, serum albumin level, and CD4 cell count, together with dose of amphotericin B, had the strongest joint association with failure to achieve negative CSF cultures by day 14. Among patients with similar CSF cryptococcal antigen titers, CD4 cell counts, and serum albumin levels, the odds of failure at week 10 for those without negative CSF cultures by day 14 was five times that for those with negative CSF cultures by day 14 (odds ratio, 5.0; 95% confidence interval, 2.2-10.9). Prognosis is dismal for patients with AIDS-related cryptococcal meningitis. Multivariate analyses identified three components that, along with initial treatment, have the strongest joint association with early outcome. Clearly, more effective initial therapy and patient management strategies that address immune function and nutritional status are needed to improve outcomes of this disease.

Keywords: JOURNAL ARTICLE Adult Amphotericin B/*THERAPEUTIC USE Antibiotics, Antifungal/*THERAPEUTIC USE Antifungal Agents/THERAPEUTIC USE AIDS-Related Opportunistic Infections/*DRUG THERAPY/MICROBIOLOGY/ MORTALITY Cerebrospinal Fluid/MICROBIOLOGY Cryptococcus/DRUG EFFECTS/ISOLATION & PURIF Drug Therapy, Combination Flucytosine/THERAPEUTIC USE Human Logistic Models Meningitis, Cryptococcal/*DRUG THERAPY/MICROBIOLOGY/MORTALITY Multivariate Analysis Serum Albumin Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Time Factors Treatment Failure
990930
A9991295

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, Gill Foundation, the National Library of Medicine, Quest Diagnostics, Roche and Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1999. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .