Long-term follow-up and survival of antiretroviral-naïve patients with cryptococcal meningitis in the pre-antiretroviral therapy era, gauteng province, South Africa

B. J. Park, S. Shetty, A. Ahlquist, A. Greenbaum, J. L. Miller, A. Motsi, K. McCarthy, N. Govender

Research output: Contribution to journalArticle

Abstract

Cryptococcal meningitis (CM) is a major cause of death among HIV-infected persons in sub-Saharan Africa. We conducted a study to describe the long-term outcomes during the pre-antiretroviral post-ART therapy period. Enrolled cases were those detected through population-based surveillance in Gauteng Province, South Africa, and diagnosed during March-November 2002 and July-September 2003 from eight large hospitals representing academic, provincial and rural settings. Of 1089 case-patients diagnosed with CM, 721 (70%) survived to discharge. Among the 256 with follow-up information, 154 (60%) were established to have died, 44% of whom died as outpatients. Overall, the 14- and 90-day survival post-diagnosis was 68% and 41%, respectively. On Cox proportional hazards multivariable analysis, severe disease was associated with shorter survival time; having received any antifungal treatment for the cryptococcal episode was associated with increased survival time at follow-up. Although most patients in this cohort survived the initial hospitalization, only 41% were still alive three months after diagnosis, with nearly half of deaths occurring outside a hospital. These data are an important baseline from which to measure effectiveness of public health management of CM in South Africa.

Original languageEnglish (US)
Pages (from-to)199-203
Number of pages5
JournalInternational Journal of STD and AIDS
Volume22
Issue number4
DOIs
StatePublished - Apr 1 2011
Externally publishedYes

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Keywords

  • AIDS
  • Cryptococcal meningitis
  • Cryptococcosis
  • Cryptococcus
  • HIV
  • South Africa
  • Survival

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Pharmacology (medical)
  • Infectious Diseases

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