Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas

Area of Science:

• Infectious Diseases
• Public Health
• HIV/AIDS Research

Background:

• Cryptococcal meningitis (CM) presents a significant mortality challenge for HIV-infected individuals.
• The burden of CM in Latin America and optimal antiretroviral therapy (ART) timing remain under-described.
• Early ART initiation may increase mortality risk, but data from the Americas are limited.

Purpose of the Study:

• To investigate the mortality rates associated with cryptococcal meningitis in HIV-infected patients across Latin America.
• To evaluate the impact of antiretroviral therapy (ART) timing on survival outcomes for patients with CM.
• To describe the epidemiological burden of CM in the Latin American region.

Main Methods:

• A cohort study included HIV-infected adults diagnosed with CM between 1985-2014 from Latin American sites (CCASAnet) and VCCC.
• Survival probabilities were estimated using Kaplan-Meier methods.
• Dynamic marginal structural models assessed the risk of death comparing ART initiation within 2 weeks versus 2-8 weeks post-CM diagnosis, adjusting for covariates.

Main Results:

• The study included 340 patients, with a 42% overall mortality rate.
• Patients diagnosed with CM after ART initiation had a significantly higher risk of death (p=0.03).
• No statistically significant difference in survival probability was observed between initiating ART within 2 weeks (29%) versus 2-8 weeks (26%) of CM diagnosis (p=0.96).

Conclusions:

• Cryptococcal meningitis carries a very high mortality rate in this Latin American cohort, particularly for those diagnosed after ART initiation.
• The findings underscore the substantial burden of CM among HIV-infected populations in Latin America.
• Further research may be needed to clarify optimal ART timing due to potential limitations in the current analysis.