Survival Time of HIV-Infected Patients with Cryptococcal Meningitis
Suthat Chottanapund MD*,***, Pratap Singhasivanon MD*, Jaranit Kaewkungwal PhD*, Kanittha Chamroonswasdi PhD**, Weerawat Manosuthi MD***
Affiliation : * Faculty of Tropical Medicine, Mahidol University, Bangkok ** Faculty of Public Health, Mahidol University, Bangkok *** Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Bangkok
Objective : To study survival time and risk factors of mortality among HIV-infected patients who had cryptococcal
meningitis.
Design : Retrospective cohort study.
Materials and Methods : Patients’ medical records of those who had HIV-infection with newly diagnosed
cryptoccocal meningitis between January 2002 and December 2004 were reviewed. Each patient was classified
into one of two groups, according to their anti-retroviral status (ART).
Results : Five hundred and forty nine patients enrolled in the present study: 281 (51.2%) in the ART+ group
and 268 (48.8%) in the ART-group. The mean age was 33.4 + 6.9 years old in the ART + group and 33.6 + 7.0
years old in the ART-group. There were more male in both groups: 207 males and 74 females in the ART+
group, and 195 males and 73 females in the ART-group. Baseline CD4 cell count of both groups was 20 (6-74)
cells/ mL and 24 (9-72) cells/ ml. About 30% of both groups of patients experienced major opportunistic
infection before cryptococcal meningitis. All patients were treated by standard amphotericin B for a 2-week
duration followed by fluconazole for an additional 8 weeks. There were no differences of baseline characteristics
between the two groups (p > 0.05). The survival rates at 12, 24, and 36 months were 92.8%, 87.4%, and 85.4%
in the ART+ group and 55.3%, 42.2%, and 36.8% in the ART– group, respectively (p < 0.01). The median
survival time in the ART- group was 15 months. From the Cox regression model, the hazard ratio for “not
received ART” was 4.87 (95%CI = 2.48-9.44, p < 0.01).
Conclusion : The present study demonstrated the substantial increasing of survival time of HIV-infected
patients with cryptococcal meningitis by initiated ART, even in a resource limited setting (no flucytosine,
local combined antiretroviral drugs with NVP based regimens).
Keywords : HIV/AIDS, Cryptococcal meningitis, Survival time, Antiretroviral therapy, GPO-VIR
