Cryptococcal Meningitis: Differences between Patients with and without HIV-Infection

Background: Cryptococcal meningitis is one of the most devastating infections, particularly in HIV-infected individuals. The increased use of immunosuppressants led to an increase in the incidence of cryptococcosis in HIV-uninfected individuals. This study aimed to compare the characteristics between groups. Methods: This retrospective cohort study was conducted from 2011 to 2021 in northern Thailand. Individuals diagnosed with cryptococcal meningitis aged ≥15 years were enrolled onto the study. Results: Out of 147 patients, 101 were individuals infected with HIV and 46 were non-infected. Factors associated with being infected with HIV included age < 45 years (OR 8.70, 95% CI 1.78-42.62), white blood cells < 5000 cells/cu.mm. (OR 7.18, 95% CI 1.45-35.61), and presence of fungemia (OR 5.86, 95% CI 1.17-42.62). Overall, the mortality rate was 24% (18% in HIV-infected vs. 37% in HIV-uninfected individuals, p-value = 0.020). Factors associated with mortality included concurrent pneumocystis pneumonia (HR 5.44, 95% CI 1.55-19.15), presence of alteration of consciousness (HR 2.94, 95% CI 1.42-6.10), infection caused by members of C. gattii species complex (HR 4.19, 95% CI 1.39-12.62), and anemia (HR 3.17, 95% CI 1.17-8.59). Conclusions: Clinical manifestations of cryptococcal meningitis differed between patients with and without HIV-infection in some aspects. Increasing awareness in physicians of this disease in HIV-uninfected individuals may prompt earlier diagnosis and timely treatment.