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Related Experiment Video

Updated: Feb 3, 2026

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HIV-Associated Cryptococcal Meningitis Occurring at Relatively Higher CD4 Counts.

Lillian Tugume1, Joshua Rhein1,2, Kathy Huppler Hullsiek2

  • 1Infectious Diseases Institute, Makerere University, Kampala, Uganda.

The Journal of Infectious Diseases
|October 17, 2018
PubMed
Summary

Cryptococcal meningitis can affect HIV patients with higher CD4 counts, presenting with altered mental status despite lower fungal burden. Immune responses differ, impacting outcomes in these cases.

Keywords:
AIDSCD4 T cellsCSF biomarkersHIVcryptococcal meningitis

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Area of Science:

  • Infectious Diseases
  • Immunology
  • HIV Medicine

Background:

  • Cryptococcal meningitis (CM) can occur in individuals with less apparent immunosuppression.
  • Evaluation of clinical characteristics and outcomes in HIV-related Cryptococcus with higher CD4 counts is crucial.

Purpose of the Study:

  • To assess clinical presentation and outcomes of HIV-infected individuals with CM and higher CD4 counts.
  • To compare participants with CD4 counts <50, 50-99, and ≥100 cells/microL.

Main Methods:

  • Prospective cohort study in Uganda and South Africa (November 2010 - May 2017).
  • Enrolled 736 participants with HIV-related cryptococcosis.
  • Compared clinical characteristics, CSF parameters, and 18-week survival across CD4 count strata.

Main Results:

  • 9% of first-episode CM cases presented with CD4 ≥100 cells/microL.
  • Participants with CD4 ≥100 cells/microL showed higher rates of altered mental status (52% vs 39%) but 10-fold lower CSF fungal burden.
  • Higher CSF levels of IL-6, IL-8, IL-13, and lower CCL2 were observed in the CD4 ≥100 group; 18-week mortality was 40% in this group versus 47% in CD4 <50 group.

Conclusions:

  • HIV-infected individuals with CM and CD4 ≥100 cells/microL present with more frequent altered mental status and lower fungal burden.
  • A greater Th2 immune response (IL-13) was noted in those with higher CD4 counts.
  • Higher CD4 counts may be protective, though immune-mediated damage is a consideration.