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https://www.arca.fiocruz.br/handle/icict/59876
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2030-12-31
Sustainable Development Goals
03 Saúde e Bem-EstarCollections
- INI - Artigos de Periódicos [3645]
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CRYPTOCOCCAL MENINGITIS AND CLINICAL OUTCOMES IN PERSONS WITH HUMAN IMMUNODEFICIENCY VIRUS: A GLOBAL VIEW
Author
Affilliation
Division of Infectious Diseases. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Departamento de Infectología. Instituto Nacional de Ciencias Médicas y Nutrición. Mexico City, Mexico.
Department of Biostatistics. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.
Division of Infectious Diseases. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Department of Infectious Diseases. Bern University Hospital. University of Bern. Bern, Switzerland.
Department of Global Health. Boston University. Boston, Massachusetts, USA.
Center for Global Health. Johns Hopkins University. Baltimore, Maryland, USA.
Department of Medicine. University of Calgary. Calgary, Alberta, Canada.
Cipto Mangunkusumo Hospital. Jakarta, Indonesia.
National Hospital of Tropical Diseases. Hanoi, Viet Nam.
Infectious Diseases Institute. College of Health Sciences. Makerere University. Kampala, Uganda.
Department of Internal Medicine. Mbarara University of Science and Technology and Mbarara Regional Referral Hospital. Mbarara, Uganda.
Department of Biostatistics. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Division of Infectious Diseases. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Departamento de Infectología. Instituto Nacional de Ciencias Médicas y Nutrición. Mexico City, Mexico.
Department of Biostatistics. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.
Division of Infectious Diseases. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Department of Infectious Diseases. Bern University Hospital. University of Bern. Bern, Switzerland.
Department of Global Health. Boston University. Boston, Massachusetts, USA.
Center for Global Health. Johns Hopkins University. Baltimore, Maryland, USA.
Department of Medicine. University of Calgary. Calgary, Alberta, Canada.
Cipto Mangunkusumo Hospital. Jakarta, Indonesia.
National Hospital of Tropical Diseases. Hanoi, Viet Nam.
Infectious Diseases Institute. College of Health Sciences. Makerere University. Kampala, Uganda.
Department of Internal Medicine. Mbarara University of Science and Technology and Mbarara Regional Referral Hospital. Mbarara, Uganda.
Department of Biostatistics. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Division of Infectious Diseases. Vanderbilt University Medical Center. Nashville, Tennessee, USA.
Abstract
Background: Cryptococcal meningitis (CM) is a major cause of morbidity and mortality in persons with human immunodeficiency virus (HIV; PWH). Little is known about CM outcomes and availability of diagnostic and treatment modalities globally. Methods: In this retrospective cohort study, we investigated CM incidence and all-cause mortality in PWH in the International Epidemiology Databases to Evaluate AIDS cohort from 1996 to 2017. We estimated incidence using quasi-Poisson models adjusted for sex, age, calendar year, CD4 cell count (CD4), and antiretroviral therapy (ART) status. Mortality after CM diagnosis was examined using multivariable Cox models. A site survey from 2017 assessed availability of CM diagnostic and treatment modalities. Results: Among 518 852 PWH, there were 3857 cases of CM with an estimated incidence of 1.54 per 1000 person-years. Mortality over a median of 2.6 years of post-CM diagnosis follow-up was 31.6%, with 29% lost to follow-up. In total, 2478 (64%) were diagnosed with CM after ART start with a median of 253 days from ART start to CM diagnosis. Older age (hazard [HR], 1.31 for 50 vs 35 years), lower CD4 (HR, 1.15 for 200 vs 350 cells/mm3), and earlier year of CM diagnosis (HR, 0.51 for 2015 vs 2000) were associated with higher mortality. Of 89 sites, 34% reported access to amphotericin B; 12% had access to flucytosine. Conclusions: Mortality after CM diagnosis was high. A substantial portion of CM cases occurred after ART start, though incidence and mortality may be higher than reported due to ascertainment bias. Many sites lacked access to recommended CM treatment.
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