Outcomes of cryptococcal meningitis in Uganda before and after the availability of highly active antiretroviral therapy.

@article{Kambugu2008OutcomesOC,
  title={Outcomes of cryptococcal meningitis in Uganda before and after the availability of highly active antiretroviral therapy.},
  author={Andrew Kambugu and David B. Meya and Joshua Rhein and M O'Brien and Edward N Janoff and Allan R. Ronald and Moses R. Kamya and Harriet Mayanja-Kizza and Merle A. Sande and Paul R. Bohjanen and David R. Boulware},
  journal={Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
  year={2008},
  volume={46 11},
  pages={
          1694-701
        }
}
  • A. Kambugu, D. Meya, +8 authors D. Boulware
  • Published 2008
  • Medicine
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
BACKGROUND Cryptococcal meningitis (CM) is the proximate cause of death in 20%-30% of persons with acquired immunodeficiency syndrome in Africa. METHODS Two prospective, observational cohorts enrolled human immunodeficiency virus (HIV)-infected, antiretroviral-naive persons with CM in Kampala, Uganda. The first cohort was enrolled in 2001-2002 (n = 92), prior to the availability of highly active antiretroviral therapy (HAART), and the second was enrolled in 2006-2007 (n = 44), when HAART was… Expand
Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis.
TLDR
Deferring ART for 5 weeks after the diagnosis of cryptococcal meningitis was associated with significantly improved survival, as compared with initiating ART at 1 to 2 weeks, especially among patients with a paucity of white cells in cerebrospinal fluid. Expand
CLINICAL OUTCOMES OF CRYPTOCOCCAL MENINGITIS AMONG HIV-INFECTED PATIENTS IN THE ERA OF ANTIRETROVIRAL THERAPY.
TLDR
The HIV-associated CM survival rate in the ART era is higher than it was during the pre-ART era and patients with poor prognostic factors could be closely monitored. Expand
Treatment of Cryptococcal Meningitis in KwaZulu-Natal, South Africa
TLDR
Even in a setting where amphotericin B is available, mortality from cryptococcal meningitis in this setting is high, particularly in the immediate period after diagnosis, which highlights the still unmet need not only for earlier diagnosis of HIV and timely access to treatment of opportunistic infections, but for better treatment strategies. Expand
Outcome of HIV-1-associated cryptococcal meningitis, Denmark 1988–2008
TLDR
It is found that long-term survival after HIV-1-associated CM has improved significantly with the use of cART, and short-term mortality was not affected by initiation of c ART and remained high. Expand
MORTALITY AFTER CLINICAL MANAGEMENT OF AIDS-ASSOCIATED CRYPTOCOCCAL MENINGITIS IN KENYA.
TLDR
CM-associated mortality in Kenya is high; there is an opportunity to improve the management and the short-term outcomes of hospitalised HIV positive patients with CM in Kenya. Expand
Determinants of two-year mortality among HIV positive patients with Cryptococcal meningitis initiating standard antifungal treatment with or without adjunctive dexamethasone in Uganda
TLDR
Long-term mortality in CCM patients remains high even among patients receiving recommended therapy, and strategies to improve long-term survival are urgently needed, especially targeting those with reduced GCS, low weight, and convulsions. Expand
Original Research: A medical audit of the management of cryptococcal meningitis in HIV-positive patients
  • 2012
Cryptococcal meningitis (CM) is caused by an opportunistic encapsulated yeast, Cryptococcus neoformans. Despite recent expansion of antiretroviral treatment (ART) programmes in developing countries,Expand
Evolving Failures in the Delivery of Human Immunodeficiency Virus Care: Lessons From a Ugandan Meningitis Cohort 2006–2016
TLDR
Although improved HIV screening and ART access remain much-needed interventions in resource-limited settings, greater investment in viral suppression and opportunistic infection care among the growing HIV-infected population receiving ART is essential to reducing ongoing AIDS mortality. Expand
High ongoing burden of cryptococcal disease in Africa despite antiretroviral roll out.
TLDR
The results show that the “treatment gap” is not narrowed, and AIDS-related illness such as cryptococcal meningitis and the associated mortality are not reduced, despite a major effort to expand access to ART throughout sub-Saharan Africa over recent years. Expand
Poor long-term outcomes for cryptococcal meningitis in rural South Africa.
TLDR
Long-term outcomes of CM are poor in routine practice and interventions to strengthen linkage to HIV treatment and care and continuation of secondary fluconazole prophylaxis are critical. Expand
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References

SHOWING 1-10 OF 31 REFERENCES
Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults
Objective Despite the recognition of Cryptococcus neoformans as a major cause of meningitis in HIV-infected adults in sub-Saharan Africa, little is known about the relative importance of thisExpand
Cryptococcocal immune reconstitution disease: a major cause of early mortality in a South African antiretroviral programme.
TLDR
The frequency of cryptococcocal immune reconstitution disease in low-income countries has not previously been reported and according to national guidelines cryptococcal meningitis was treated with fluconazole 400 mg/day for 8 weeks followed by 200 mg/ day as secondary prophylaxis. Expand
Cryptococcal meningitis in human immunodeficiency virus-infected patients in Harare, Zimbabwe.
TLDR
This study provides a unique basis for the development of novel management strategies for patients with cryptococcal meningitis who reside in resource-poor countries. Expand
Determinants of Disease Presentation and Outcome during Cryptococcosis: The CryptoA/D Study
TLDR
Sex, HIV status, and infecting serotype are major determinants of presentation and outcome during cryptococcosis, and a modification of current guidelines for the initial management of cryptocococcosis is proposed based on systematic fungal burden evaluation. Expand
Outcome of AIDS-associated cryptococcal meningitis initially treated with 200 mg/day or 400 mg/day of fluconazole
TLDR
Outcome of AIDS-associated cryptococcal meningitis is similar with low or standard doses of fluconazole, and initial therapy with amphotericin B and other measures may be needed to improve outcome. Expand
Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy
TLDR
Overall survival after cryptococcosis has dramatically improved at the cART era and Immune restoration and low serum cryptococcal antigen titres are associated with lower cryptococcotic relapse rates. Expand
Impact of antiretroviral therapy on the relapse of cryptococcosis and survival of HIV-infected patients with cryptococcal infection.
TLDR
ART significantly reduced relapse and mortality rate from cryptococcal-related mortality rate in HIV-infected patients and should not be delayed. Expand
A prospective study of AIDS-associated cryptococcal meningitis in Thailand treated with high-dose amphotericin B.
TLDR
High-dose amphotericin B was not as effective as previously thought in treating AIDS-associated cyptococcal meningitis and prognostic factors affecting survival after high- doses followed by oral azole treatment. Expand
Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients
TLDR
All patients suspected to have meningitis had a high HIV sero positivity irrespective of whether they were later confirmed to haveMeningitis or not and in-hospital mortality was high irrespective of the cause of Meningitis. Expand
The Impact of HIV on Meningitis as Seen at a South African Academic Hospital (1994 to 1998)
TLDR
Over a 4-year period the HIV epidemic was responsible for a marked shift in the spectrum of meningitis towards chronic infections such as TB and cryptococcalMeningitis at the PAH. Expand
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