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Mortality in first-episode HIV-associated cryptococcal meningitis in Peru.
Juan José Montenegro-Idrogo1, Luz Quispe-Gárate2, Blanca Salazar3
1Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima 15067, Peru.
Medical Mycology
|December 23, 2025
Summary
Mortality from cryptococcal meningitis (CM) in people with HIV remains high in resource-limited settings. Early diagnosis and optimal antifungal therapy are crucial for improving survival outcomes in HIV-associated CM.
Area of Science:
- Infectious Diseases
- Public Health
- HIV/AIDS Research
Background:
- Cryptococcal meningitis (CM) is a major cause of death in people with HIV, especially in low-income countries.
- Limited access to diagnostics and treatment hinders effective management of CM in resource-limited settings.
Purpose of the Study:
- To identify predictors of mortality in HIV-associated CM.
- To evaluate the impact of treatment strategies on survival in HIV-associated CM.
Main Methods:
- Retrospective cohort study of HIV patients with CM at a Peruvian national referral hospital (2005-2015).
- Cox proportional hazards models used to analyze 30- and 90-day mortality.
- Analysis included baseline characteristics and antifungal treatment regimens.
Main Results:
- Overall 30-day and 90-day mortality rates were 26.5% and 31.3%, respectively.
- Altered consciousness and hyponatremia were independent predictors of increased mortality.
- Fluconazole monotherapy or no antifungal treatment was associated with significantly higher mortality.
Conclusions:
- Mortality from HIV-associated CM is unacceptably high in resource-limited settings.
- Urgent need to improve early diagnostic strategies for CM.
- Ensuring access to optimal antifungal therapy is critical to reduce CM-related deaths in people with HIV.
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